MEDICARE: ESTHER B. MACHEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D4356	ID

General Provider Information

NPI Number	:	1194046037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER B. MACHEN DDS

Provider Business Mailing Address
First Line	:	3500 POTOMAC WAY
Second Line	:	SUITE 200
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4974
Country	:	US
Telephone Number	:	208-552-0775
Fax Number	:	208-522-4077

Provider Business Practice Location Address
First Line	:	3500 POTOMAC WAY
Second Line	:	SUITE 200
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-4974
Country	:	US
Telephone Number	:	208-552-0775
Fax Number	:	208-522-4077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	08/04/2015

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