Organization
MARK A. TALL, P.A.
Active
Other names
Sandcreek Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ASAEL TALL D.D.S. (PRESIDENT)
(208) 525-4780
Entity
Organization
Contact information
Practice address
2460 E 25TH ST, IDAHO FALLS, ID 83404-7549
(208) 525-4780
(208) 525-4785
Mailing address
5600 SOLITUDE DR, IDAHO FALLS, ID 83406-8247
(208) 524-4242
(208) 524-1139
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-2018
ID
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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