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General NPI Number Information
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NPI Number | 1063157105
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Entity Type | Organization
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Legal Business Name | SLEEP BETTER IDAHO FALLS LLC
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 2238 SARATOGA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5109
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Country | US
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Telephone | 208-701-2720
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Fax | 208-701-2939
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Provider Business Mailing Address
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Address Line | 2238 SARATOGA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5109
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Country | US
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Telephone | 208-701-2720
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK A TALL
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Credential | DDS
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Telephone | 208-701-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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