| Clubhouse Pediatric Dentistry Of Madison | |
|
859 S Yellowstone Hwy Rexburg ID 83440-5293 | |
| (208) 552-5439 | |
| Not Available |
| Full Name | Clubhouse Pediatric Dentistry Of Madison |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 859 S Yellowstone Hwy, Rexburg, Idaho |
| Authorized Official Name and Position | Jennifer Louise Robison (FINANCIAL COORDINATOR) |
| Authorized Official Contact | 2085201514 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clubhouse Pediatric Dentistry Of Madison 859 S Yellowstone Hwy Rexburg ID 83440-5293 Ph: (208) 552-5439 | Clubhouse Pediatric Dentistry Of Madison 859 S Yellowstone Hwy Rexburg ID 83440-5293 Ph: (208) 552-5439 |
| NPI Number | 1306321351 |
|---|---|
| Provider Enumeration Date | 09/26/2018 |
| Last Update Date | 09/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306321351 | NPI | - | NPPES |
| 28954 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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