| Comfort Care Dental Of Rexburg, Pllc | |
|
242 E Main St Rexburg ID 83440-2022 | |
| (208) 359-2345 | |
| (208) 359-1890 |
| Full Name | Comfort Care Dental Of Rexburg, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 242 E Main St, Rexburg, Idaho |
| Authorized Official Name and Position | Layne Edwin Hacking (OWNER) |
| Authorized Official Contact | 2083592345 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Comfort Care Dental Of Rexburg, Pllc 242 E Main St Rexburg ID 83440-2022 Ph: (208) 359-2345 | Comfort Care Dental Of Rexburg, Pllc 242 E Main St Rexburg ID 83440-2022 Ph: (208) 359-2345 |
| NPI Number | 1093975211 |
|---|---|
| Provider Enumeration Date | 06/11/2008 |
| Last Update Date | 05/23/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093975211 | NPI | - | NPPES |
| 807030600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D-3740 (Idaho) | Primary |
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