Andrew Stoddard Dental Services, PLLC
Organization Active NPI Dental Clinic/Center · Pocatello, ID
NPI 1346501657 · NPPES record last updated Jun 4, 2012
Key facts
- NPI
- 1346501657
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- License
- D-4149 (ID)
- Legal business name
- ANDREW STODDARD DENTAL SERVICES, PLLC
- Practice address
- 1525 Baldy Ave
Pocatello, ID 83201-7117 - Phone
- (208) 238-0011
- NPI assigned
- Jun 4, 2012
- Organization subpart
- No
Authorized official
- Name
- Andrew Stoddard, DDS
- Title
- Sole Member
- Phone
- (208) 238-0011
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | D-4149 | ID | Yes |
Addresses
Primary practice location
1525 Baldy Ave
Pocatello, ID 83201-7117
Mailing address
1525 Baldy Ave
Pocatello, ID 83201-7117
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.