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Organization
MARK A. TALL, P.A.
Active
Organization
MARK A. TALL, P.A.
Active
Other names
Sandcreek Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ASAEL TALL D.D.S. (PRESIDENT)
(208) 525-4780
Entity
Organization
Contact information
Practice address
2460 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 525-4780
(208) 525-4785
Mailing address
5600 SOLITUDE DR, IDAHO FALLS, ID 83406-8247
(208) 524-4242
(208) 524-1139
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-2018
ID
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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