1972519551 NPI number — DR. MARK A PLANT DDS, PA

Table of content: DR. MARK A PLANT DDS, PA (NPI 1972519551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972519551 NPI number — DR. MARK A PLANT DDS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLANT
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972519551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2064 WASHINGTON ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-3071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-734-1097
Provider Business Mailing Address Fax Number:
208-735-5160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2064 WASHINGTON ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-3071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-734-1097
Provider Business Practice Location Address Fax Number:
208-735-5160
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  D-3129-OS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 534917 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 6D626 . This is a "BLUE CROSS OF IDAHODENTAL" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 6M048 . This is a "BLUE CROSS OF IDAHO MED" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: BLUE SHIELD . This is a "45250" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002577900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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