| Madison Pediatric Dentistry | |
|
859 S Yellowstone Hwy Ste 1202 Rexburg ID 83440-6201 | |
| (208) 552-5439 | |
| (208) 552-5440 |
| Full Name | Madison Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 859 S Yellowstone Hwy Ste 1202, Rexburg, Idaho |
| Authorized Official Name and Position | Ross N Hugues (OWNER/PEDIATRIC DENTIST) |
| Authorized Official Contact | 2085525439 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Pediatric Dentistry 859 S Yellowstone Hwy Ste 1202 Rexburg ID 83440-6201 Ph: (208) 552-5439 | Madison Pediatric Dentistry 859 S Yellowstone Hwy Ste 1202 Rexburg ID 83440-6201 Ph: (208) 552-5439 |
| NPI Number | 1013188804 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 02/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013188804 | NPI | - | NPPES |
| 807793700 | Medicaid | ID | |
| 6P475 | Other | ID | BLUECROSS OF IDAHO |
| 9202516 | Other | MEDICAID - IDAHO SMILES | |
| 000010165079 | Other | ID | REGENCE BLUESHIELD OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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