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Organization
MARK S. OLIVERSON, D.M.D.
Active
Organization
MARK S. OLIVERSON, D.M.D.
Active
Other names
Salmon Dental Center PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S. OLIVERSON D.M.D. (GENERAL DENTIST)
(208) 756-2262
Entity
Organization
Contact information
Practice address
207 MARGARET ST, SALMON, ID 83467-4400
(208) 756-2262
(208) 756-4473
Mailing address
207 MARGARET ST, SALMON, ID 83467-4400
(208) 756-2262
(208) 756-4473
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4013
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807527500
—
ID
01
—
9202414
IDAHO SMILES
ID
Enumeration date
06/30/2008
Last updated
10/09/2014
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