Organization
APPLE TREE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LARSEN DDS (OWNER)
(208) 219-7585
Entity
Organization
Contact information
Practice address
33 WINN DR, SUITE 2, REXBURG, ID 83440-5277
(208) 522-7036
Mailing address
33 WINN DR, SUITE 2, REXBURG, ID 83440-5277
(208) 522-7036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/21/2017
Last updated
04/21/2017
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