Clubhouse Pediatric Dentistry Of Madison

LBN: Clubhouse Pediatric Dentistry Of Madison
Clubhouse Pediatric Dentistry Of Madison is an health care organization with primary practice located at 859 S Yellowstone Hwy , Rexburg ID 83440-5293. The organization recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as the primary health care specialty. Clubhouse Pediatric Dentistry Of Madison can be contacted via phone (208) 552-5439, or through Robison, Jennifer Louise via phone (208) 520-1514.

Contact Information

Primary practice address
859 S Yellowstone Hwy Rexburg ID 83440-5293
Phone: (208) 552-5439
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Robison, Jennifer Louise
Phone: (208) 520-1514

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X

Profile Details

NPI number 1306321351
LBN Legal business name Clubhouse Pediatric Dentistry Of Madison
DBA Doing business as
Authorized official Robison, Jennifer Louise
Entity Organization
Organization subpart 1 No
Enumeration date Sep 26th, 2018
Last updated Sep 26th, 2018 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1306321351 NPPES
Idaho MEDICAID 28954

Popular Providers