| Madison Park Dental Center Pllc | |
|
35 Madison Professional Park Rexburg ID 83440 | |
| (208) 356-5601 | |
| (208) 356-8788 |
| Full Name | Madison Park Dental Center Pllc |
|---|---|
| Speciality | Dentist |
| Location | 35 Madison Professional Park, Rexburg, Idaho |
| Authorized Official Name and Position | Robert L Walker (PRESIDENT) |
| Authorized Official Contact | 2083565601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Park Dental Center Pllc 35 Madison Professional Park Rexburg ID 83440 Ph: (208) 356-5601 | Madison Park Dental Center Pllc 35 Madison Professional Park Rexburg ID 83440 Ph: (208) 356-5601 |
| NPI Number | 1093849226 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093849226 | NPI | - | NPPES |
| 6I120 | Other | ID | BLUE CROSS |
| 80659700 | Medicaid | ID | |
| 6I138 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D1657 D3634 (Idaho) | Primary |
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