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Organization
COMFORT CARE DENTAL OF REXBURG, PLLC
Active
Organization
COMFORT CARE DENTAL OF REXBURG, PLLC
Active
Other names
Madison Clinic Dentistry, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAYNE EDWIN HACKING D.M.D. (OWNER)
(208) 359-2345
Entity
Organization
Contact information
Practice address
242 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-2345
(208) 359-1890
Mailing address
242 E MAIN ST, REXBURG, ID 83440-2022
(208) 359-2345
(208) 359-1890
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3740
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807030600
—
ID
Enumeration date
06/11/2008
Last updated
05/23/2016
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