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Organization
MADISON PARK DENTAL CENTER PLLC
Active
Organization
MADISON PARK DENTAL CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT L WALKER (PRESIDENT)
(208) 356-5601
Entity
Organization
Contact information
Practice address
35 MADISON PROFESSIONAL PARK, REXBURG, ID 83440
(208) 356-5601
(208) 356-8788
Mailing address
35 MADISON PROFESSIONAL PARK, REXBURG, ID 83440
(208) 356-5601
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1657 D3634
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6I120
BLUE CROSS
ID
01
—
6I138
BLUE CROSS
ID
05
—
80659700
—
ID
Enumeration date
03/16/2007
Last updated
08/22/2020
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