|
| |
|
242 E Main St Rexburg ID 83440-2022 | |
| (208) 359-2345 | |
| (208) 359-1890 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 242 E Main St, Rexburg, Idaho |
| Authorized Official Name and Position | Layne Edwin Hacking (OWNER) |
| Authorized Official Contact | 2083592345 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
242 E Main St Rexburg ID 83440-2022 Ph: (208) 359-2345 | 242 E Main St Rexburg ID 83440-2022 Ph: (208) 359-2345 |
| NPI Number | 1093975211 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 05/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093975211 | NPI | - | NPPES |
| 807030600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3740 (Idaho) | Primary |
Cornerstone Family Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 44 S Center St, Rexburg, ID 83440 Phone: 208-356-4240 Fax: 208-356-5361 | |
Jeppson Endodontics, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 E Main St, Suite 202, Rexburg, ID 83440 Phone: 208-357-4826 | |
Madison Park Dental Center Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 35 Madison Professional Park, Rexburg, ID 83440 Phone: 208-356-5601 Fax: 208-356-8788 | |
Dental Health Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 56 Professional Plz, Rexburg, ID 83440 Phone: 208-356-9262 Fax: 208-356-4804 |