Comfort Care Dental of Rexburg, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3740 Issued in ID

Legal business name

COMFORT CARE DENTAL OF REXBURG, PLLC

Practice address

242 E Main St
Rexburg, ID 83440-2022

Phone

(208) 359-2345

Fax

(208) 359-1890

NPI assigned

Jun 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Layne Edwin Hacking, D.M.D.NPI 1306945001

Title

Owner

Phone

(208) 359-2345

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Madison Clinic Dentistry, PC Former legal business name

Locations

Practitioners 1

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.

• Layne E Hacking, DMD

  • General Practice Dentistry
  • Rexburg, ID
  • NPI 1306945001
  NPD (past) Authorized official

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463961600000",
    "number": "1093975211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-2345",
            "fax_number": "208-359-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 E MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402022",
            "telephone_number": "208-359-2345",
            "fax_number": "208-359-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMFORT CARE DENTAL OF REXBURG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2016-05-23",
        "status": "A",
        "authorized_official_last_name": "HACKING",
        "authorized_official_first_name": "LAYNE",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-359-2345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807030600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison Clinic Dentistry, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Mark J Coglianese, MPT
• Saralou Colson, LCPC, NCC
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• General Practice Dentistry in Rexburg, ID
• Providers in Rexburg, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2016; 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.