Madison Park Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4747 Issued in ID

Legal business name

MADISON PARK DENTAL CENTER

Practice address

35 Madison Professional Park
Rexburg, ID 83440-2057

Phone

(208) 356-5601

Fax

(208) 356-8788

NPI assigned

May 5, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Mark A Tall

Title

Owner

Phone

(208) 356-5601

Specialties & licenses 2

Addresses

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.

• James C. Allen, D.D.S.

  • Dentist
  • Rexburg, ID
  • NPI 1356352090

  General Practice

  NPD (past)
• Robert L. Walker, D.M.D.

  • Dentist
  • Rexburg, ID
  • NPI 1548271273
  NPD (past)

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1831545102",
    "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": "834402057",
            "telephone_number": "208-356-5601",
            "fax_number": "208-356-8788"
        },
        {
            "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": "834402057",
            "telephone_number": "208-356-5601",
            "fax_number": "208-356-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PARK DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-05",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "TALL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-356-5601",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4747",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D2018",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Ear Nose and Throat Clinic
• Madison Foot & Ankle Care, PA
• Madison General Surgery Clinic
• Madison Memorial Hospital (Madison Clinic Physicians)
• Madison Memorial Hospital
• Madison Park Dental Center PLLC
• Madison Physician Services
• Madison Ridge Chiropractic
• Madison Women's Clinic
• Madison Women's Clinic, PLLC

• 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 5, 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.