Healthcare Provider Details

I. General information

NPI: 1558363341
Provider Name (Legal Business Name): DAVID M DENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 HOSPITAL WAY BUILDING F
POCATELLO ID
83201-5091
US

IV. Provider business mailing address

1151 HOSPITAL WAY BUILDING F
POCATELLO ID
83201-5091
US

V. Phone/Fax

Practice location:
  • Phone: 208-232-1443
  • Fax: 208-239-3434
Mailing address:
  • Phone: 208-232-1443
  • Fax: 208-239-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberM-7586
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: