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Organization
MADISON PARK DENTAL CENTER
Active
Organization
MADISON PARK DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A TALL (OWNER)
(208) 356-5601
Entity
Organization
Contact information
Practice address
35 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-5601
(208) 356-8788
Mailing address
35 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2057
(208) 356-5601
(208) 356-8788
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
D2018
ID
1223G0001X
General Practice Dentistry
Primary
D4747
ID
Other
Enumeration date
05/05/2016
Last updated
05/05/2016
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