Organization
MARK S. OLIVERSON, D.M.D.
Active
Other names
Salmon Dental Center PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK S. OLIVERSON D.M.D. (GENERAL DENTIST)
(208) 756-2262
Entity
Organization
Contact information
Practice address
207 MARGARET ST, SALMON, ID 83467-4400
(208) 756-2262
(208) 756-4473
Mailing address
207 MARGARET ST, SALMON, ID 83467-4400
(208) 756-2262
(208) 756-4473
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-4013
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807527500
—
ID
01
—
9202414
IDAHO SMILES
ID
Enumeration date
06/30/2008
Last updated
10/09/2014
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