Healthcare Provider Details

I. General information

NPI: 1700046257
Provider Name (Legal Business Name): DR MARK A PLANT, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 WASHINGTON ST N
TWIN FALLS ID
83301-3071
US

IV. Provider business mailing address

2064 WASHINGTON ST N
TWIN FALLS ID
83301-3071
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-1097
  • Fax: 208-735-5160
Mailing address:
  • Phone: 208-734-1097
  • Fax: 208-735-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD3129OS
License Number StateID

VIII. Authorized Official

Name: DR. MARK A PLANT
Title or Position: DOCTOR
Credential: DDS
Phone: 208-734-1097