| NPI | 1093975211 |
|---|---|
| Former Legal Business Name | MADISON CLINIC DENTISTRY, PC |
| Entity Type | Organization |
| Authorized Contact | LAYNE EDWIN HACKING Owner 208-359-2345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-3740) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2016-05-23 |