Provider Demographics
NPI:1730348806
Name:CALL FAMILY DENTISTRY
Entity type:Organization
Organization Name:CALL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-233-2500
Mailing Address - Street 1:1352 E CENTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4769
Mailing Address - Country:US
Mailing Address - Phone:208-233-2500
Mailing Address - Fax:208-233-2603
Practice Address - Street 1:1352 E CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4769
Practice Address - Country:US
Practice Address - Phone:208-233-2500
Practice Address - Fax:208-233-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002640700Medicaid
PA779347OtherUNITED CONCORDIA
ID10009571OtherREGENCE BLUE CROSS
ID61192OtherBLUE CROSS OF IDAHO