# COMFORT CARE DENTAL OF REXBURG, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Madison Clinic Dentistry, PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093975211
- **Authorized official:** DR. LAYNE EDWIN HACKING D.M.D. (OWNER)
- **Authorized official phone:** (208) 359-2345

## Contact information

- **Practice address:** 242 E MAIN ST, REXBURG, ID 83440-2022
- **Practice address phone:** (208) 359-2345
- **Practice address fax:** (208) 359-1890
- **Mailing address:** 242 E MAIN ST, REXBURG, ID 83440-2022
- **Mailing address phone:** (208) 359-2345
- **Mailing address fax:** (208) 359-1890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D-3740 | ID | Yes |

## Other

- **Enumeration date:** 06/11/2008
- **Last updated:** 05/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807030600 | — | ID |