# MARK A. TALL, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sandcreek Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275795395
- **Authorized official:** DR. MARK ASAEL TALL D.D.S. (PRESIDENT)
- **Authorized official phone:** (208) 525-4780

## Contact information

- **Practice address:** 2460 E 25TH ST, IDAHO FALLS, ID 83404-7549
- **Practice address phone:** (208) 525-4780
- **Practice address fax:** (208) 525-4785
- **Mailing address:** 5600 SOLITUDE DR, IDAHO FALLS, ID 83406-8247
- **Mailing address phone:** (208) 524-4242
- **Mailing address fax:** (208) 524-1139

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D-2018 | ID | Yes |

## Other

- **Enumeration date:** 06/30/2008
- **Last updated:** 06/30/2008