NPI 1063515062

Mark Asael Tall, DDS

Practitioner General Practice Dentistry Idaho Falls, ID

Practice location

Address: 2460 E 25th St, Idaho Falls, ID 83404
Phone: (208) 525-4780
Fax: (508) 525-4785
Mailing address: 5600 Solitude Ln, Idaho Falls, ID 83406

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence D2018 (ID)

Other Dentist providers in Idaho →

Registry record

NPI: 1063515062
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Sep 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.