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General NPI Number Information
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NPI Number | 1679860829
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Entity Type | Organization
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Legal Business Name | MACHEN FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 3500 POTOMAC WAY SUITE 200
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4974
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Country | US
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Telephone | 208-552-0775
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 POTOMAC WAY SUITE 200
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City | IDAHO FALLS
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State | ID
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Zip | 83404-4974
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Country | US
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Telephone | 208-552-0775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ESTHER B MACHEN
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Credential | D.D.S.
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Telephone | 208-552-0775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-4356
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License Number State | ID
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