| Madison Park Dental Center | |
|
35 Madison Professional Park Rexburg ID 83440-2057 | |
| (208) 356-5601 | |
| (208) 356-8788 |
| Full Name | Madison Park Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 35 Madison Professional Park, Rexburg, Idaho |
| Authorized Official Name and Position | Mark A Tall (OWNER) |
| Authorized Official Contact | 2083565601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Park Dental Center 35 Madison Professional Park Rexburg ID 83440-2057 Ph: (208) 356-5601 | Madison Park Dental Center 35 Madison Professional Park Rexburg ID 83440-2057 Ph: (208) 356-5601 |
| NPI Number | 1831545102 |
|---|---|
| Provider Enumeration Date | 05/05/2016 |
| Last Update Date | 05/05/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831545102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D4747 (Idaho) | Primary |
| 1223G0001X | Dentist - General Practice | D2018 (Idaho) | Secondary |
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