Healthcare Provider Details

I. General information

NPI: 1699817684
Provider Name (Legal Business Name): DENTURE ARTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 E. CENTER SUITE A-1
POCATELLO ID
83201
US

IV. Provider business mailing address

1448 E. CENTER SUITE A-1
POCATELLO ID
83201
US

V. Phone/Fax

Practice location:
  • Phone: 208-238-1100
  • Fax: 208-233-4933
Mailing address:
  • Phone: 208-238-1100
  • Fax: 208-233-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HOWELL
Title or Position: PRESIDENT
Credential: LD
Phone: 208-238-1100