Madison Park Dental Center PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

D1657 D3634 Issued in ID

Legal business name

MADISON PARK DENTAL CENTER PLLC

Practice address

35 Madison Professional Park
Rexburg, ID 83440

Phone

(208) 356-5601

Fax

(208) 356-8788

NPI assigned

Mar 16, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert L WalkerNPI 1548271273

Title

President

Phone

(208) 356-5601

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert L. Walker, D.M.D.

  • Dentist
  • Rexburg, ID
  • NPI 1548271273
  NPD (past) Authorized official
• James C. Allen, D.D.S.

  • Dentist
  • Rexburg, ID
  • NPI 1356352090
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093849226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-356-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MADISON PROFESSIONAL PARK",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-356-5601",
            "fax_number": "208-356-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PARK DENTAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-356-5601",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1657       D3634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6I120",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80659700",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "6I138",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Foot & Ankle Care, PA
• Madison General Surgery Clinic
• Madison Memorial Hospital (Madison Clinic Physicians)
• Madison Memorial Hospital
• Madison Park Dental Center
• Madison Physician Services
• Madison Ridge Chiropractic
• Madison Women's Clinic
• Madison Women's Clinic, PLLC
• Manage With Love LLC

• Dentist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.