Individual
MARK ASAEL TALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2460 E 25TH ST, IDAHO FALLS, ID 83404
(208) 525-4780
(508) 525-4785
Mailing address
5600 SOLITUDE LN, IDAHO FALLS, ID 83406
(208) 524-4242
(208) 524-1139
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D2018
ID
Other
Enumeration date
09/06/2006
Last updated
07/08/2007
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