| Kidds Dental | |
|
716 Yellowstone Ave Pocatello ID 83201-4407 | |
| (208) 478-5437 | |
| (208) 232-5490 |
| Full Name | Kidds Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 716 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Larry W Bybee (OWNER) |
| Authorized Official Contact | 2084785437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidds Dental 716 Yellowstone Ave Pocatello ID 83201-4407 Ph: (208) 478-5437 | Kidds Dental 716 Yellowstone Ave Pocatello ID 83201-4407 Ph: (208) 478-5437 |
| NPI Number | 1114067105 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 11/30/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114067105 | NPI | - | NPPES |
| 806808801 | Medicaid | ID | |
| 806808800 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D1664 (Idaho) | Primary |
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