# APPLE TREE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477088086
- **Authorized official:** MICHAEL LARSEN DDS (OWNER)
- **Authorized official phone:** (208) 219-7585

## Contact information

- **Practice address:** 33 WINN DR, SUITE 2, REXBURG, ID 83440-5277
- **Practice address phone:** (208) 522-7036
- **Mailing address:** 33 WINN DR, SUITE 2, REXBURG, ID 83440-5277
- **Mailing address phone:** (208) 522-7036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 04/21/2017
- **Last updated:** 04/21/2017