Mark a. Tall, P.a.

Primary specialty

DentistTaxonomy code 122300000X

License

D-2018 Issued in ID

Legal business name

MARK A. TALL, P.A.

Doing business as

Sandcreek Dental

Practice address

2460 E 25TH St
Idaho Falls, ID 83404-7549

Phone

(208) 525-4780

Fax

(208) 525-4785

NPI assigned

Jun 30, 2008

Last updated

Jun 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark Asael Tall, D.D.S.NPI 1063515062

Title

President

Phone

(208) 525-4780

Specialties & licenses 1

Addresses

Other names 1

• Sandcreek Dental Doing business as

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.

• Mark Asael Tall, DDS

  • General Practice Dentistry
  • Idaho Falls, ID
  • NPI 1063515062
  NPD (past) Authorized official
• Jacob Tall

  • Dentist
  • Idaho Falls, ID
  • NPI 1265056121
  NPD (past)

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1275795395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 SOLITUDE DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834068247",
            "telephone_number": "208-524-4242",
            "fax_number": "208-524-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 E 25TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047549",
            "telephone_number": "208-525-4780",
            "fax_number": "208-525-4785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A. TALL, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "TALL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ASAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-525-4780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-2018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sandcreek Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jared K. Manwaring, MD
• Margaret C Huggins Chartered
• Margaret Leverett, Rncnp, PLLC
• Michael Adam Marion, LPN
• Mark a Weight MD PC
• Mark Bennett PLLC
• Mark E Freeman M.D. PC (Freeman Plastic Surgery)
• Mark E Freeman MD PC
• Mark E Hinkson Dermatology PA (Mountain West Dermatology)
• Leslie Markiel, LMT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.