Provider Demographics
NPI:1700046257
Name:DR MARK A PLANT, DDS PA
Entity Type:Organization
Organization Name:DR MARK A PLANT, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-734-1097
Mailing Address - Street 1:2064 WASHINGTON ST N
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3071
Mailing Address - Country:US
Mailing Address - Phone:208-734-1097
Mailing Address - Fax:208-735-5160
Practice Address - Street 1:2064 WASHINGTON ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3071
Practice Address - Country:US
Practice Address - Phone:208-734-1097
Practice Address - Fax:208-735-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3129OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty