Provider Demographics
NPI:1972519551
Name:PLANT, MARK A (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:PLANT
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3129-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID534917OtherUNITED CONCORDIA
ID6D626OtherBLUE CROSS OF IDAHODENTAL
ID6M048OtherBLUE CROSS OF IDAHO MED
IDBLUE SHIELDOther45250
ID002577900Medicaid
ID6D626OtherBLUE CROSS OF IDAHODENTAL