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Clubhouse Pediatric Dentistry Of Madison
Pediatric Dentist in Rexburg, Idaho
NPI 1306321351

Clubhouse Pediatric Dentistry Of Madison is a Pediatric Dentist based in Rexburg, ID and is specialized in Pediatric Dentistry. Clubhouse Pediatric Dentistry Of Madison practices in Rexburg, ID. The NPI Number for Clubhouse Pediatric Dentistry Of Madison is 1306321351 and holds a License No. (Idaho).

The current practice location address for Clubhouse Pediatric Dentistry Of Madison is 859 S Yellowstone Hwy, Rexburg, ID and can be reached out via phone at 208-552-5439.

Location: 859 S Yellowstone Hwy, Rexburg, ID, 83440-5293
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1306321351
Provider Name
Clubhouse Pediatric Dentistry Of Madison
Credential
Provider Entity Type
Organization
Address
859 S Yellowstone Hwy, Rexburg, ID, 83440-5293
Phone Number
208-552-5439
Fax Number
Provider Enumeration Date
09/26/2018
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
28954 05 ID
institution
Provider Business Practice Location Address Details
Address
859 S Yellowstone Hwy
City
Rexburg
State
Idaho
Zip
83440-5293
Phone Number
208-552-5439
Fax Number
person
Provider Business Mailing Address Details
Address
859 S Yellowstone Hwy
City
Rexburg
State
Idaho
Zip
83440-5293
Phone Number
208-552-5439
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
()
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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