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Contact Information

BLACKROCK DENTAL PARTNERS, PLLC
1606 E. CENTER ST.
POCATELLO, ID83201-4007
 Phone: 208-232-5294
 Fax: 208-233-5188
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for BLACKROCK DENTAL PARTNERS, PLLC

NPI Number 1356643308
LBN Legal business name BLACKROCK DENTAL PARTNERS, PLLC
Authorized official JOSHUA GIBBONS - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/24/2010
Last updated 11/27/2019 - About 7 years ago
Identifiers
ID License # D4330
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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