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General NPI Number Information
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NPI Number | 1700046257
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Entity Type | Organization
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Legal Business Name | DR MARK A PLANT, DDS PA
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 2064 WASHINGTON ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3071
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Country | US
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Telephone | 208-734-1097
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Fax | 208-735-5160
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Provider Business Mailing Address
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Address Line | 2064 WASHINGTON ST N
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City | TWIN FALLS
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State | ID
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Zip | 83301-3071
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Country | US
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Telephone | 208-734-1097
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Fax | 208-735-5160
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MARK A PLANT
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Credential | DDS
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Telephone | 208-734-1097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D3129OS
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License Number State | ID
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