Provider Demographics
NPI:1194046037
Name:MACHEN, ESTHER B (DDS)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:B
Last Name:MACHEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 POTOMAC WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4974
Mailing Address - Country:US
Mailing Address - Phone:208-552-0775
Mailing Address - Fax:208-522-4077
Practice Address - Street 1:3500 POTOMAC WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4974
Practice Address - Country:US
Practice Address - Phone:208-552-0775
Practice Address - Fax:208-522-4077
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD43561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice