# EAGLE ROCK DENTAL CARE OF REXBURG

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

## Provider details

- **NPI number:** 1831213149
- **Authorized official:** TRUDEE L CHAPPLE (ADMINISTRATOR)
- **Authorized official phone:** (208) 359-2224

## Contact information

- **Practice address:** 556 TREJO ST STE C, REXBURG, ID 83440-2626
- **Practice address phone:** (208) 359-2224
- **Practice address fax:** (208) 359-2250
- **Mailing address:** 556 TREJO ST STE C, REXBURG, ID 83440-2626
- **Mailing address phone:** (208) 359-2224
- **Mailing address fax:** (208) 359-2250

## Taxonomy

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

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 03/06/2013