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MADISON PARK DENTAL CENTER PLLC NPI 1093849226


NPI Information

NPI: 1093849226
Provider Name: MADISON PARK DENTAL CENTER PLLC
Classification: Dentist - 122300000X
Entity Type: Organization
Address:
35 MADISON PROFESSIONAL PARK
REXBURG, ID
ZIP 83440
Phone: (208) 356-5601
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MADISON PARK DENTAL CENTER PLLC is a dentist in Rexburg, ID. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. MADISON PARK DENTAL CENTER PLLC NPI is 1093849226. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

35 MADISON PROFESSIONAL PARK
REXBURG, ID
ZIP 83440
Phone: (208) 356-5601
Fax: (208) 356-8788

The provider's authorized official is Robert L Walker .
The authorized official title is President and has the following contact phone number (208) 356-5601.

The enumeration date for this NPI number is 3/16/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentistD1657 D3634IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
16I138OTHERIDAHOBLUE CROSS
26I120OTHERIDAHOBLUE CROSS
380659700MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.