Healthcare Provider Details

I. General information

NPI: 1396656427
Provider Name (Legal Business Name): MP FAMILY DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 BRIAN AVE
CALDWELL ID
83605-6305
US

IV. Provider business mailing address

1531 BANFF ST
MIDDLETON ID
83644-4402
US

V. Phone/Fax

Practice location:
  • Phone: 208-728-4500
  • Fax:
Mailing address:
  • Phone: 801-309-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA MARIE PYSNAK
Title or Position: OWNER
Credential: DDS
Phone: 801-309-4444