National Provider Identifier Database

CLARK ORAL FACIAL SURGERY BURLEY
Oral and Maxillofacial Surgery

The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.


Contact Information

CLARK ORAL & FACIAL SURGERY - BURLEY
1404 POMERELLE AVE STE A2
BURLEY, ID83318-2013
Phone: 208-831-2901
Fax: 208-736-6249
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for CLARK ORAL & FACIAL SURGERY - BURLEY

NPI Number 1356133870
Legal business name
LBN
CLARK ORAL & FACIAL SURGERY - BURLEY
Authorized official DURELLA HOLMES - (PRACTICE MANAGER)
Entity Organization
Organization subpart Yes
Enumeration date 05/20/2025
Last updated 05/20/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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