Provider Demographics
NPI:1518071976
Name:ORMOND, ERROL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:K
Last Name:ORMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4511
Mailing Address - Country:US
Mailing Address - Phone:208-478-4449
Mailing Address - Fax:208-478-1181
Practice Address - Street 1:675 YELLOWSTONE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4511
Practice Address - Country:US
Practice Address - Phone:208-478-4449
Practice Address - Fax:208-478-1181
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD13921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID82049457413002OtherBLUE CROSS/BLUE SHIELD UT
ID576387OtherUNITED CONCORDIA