CLARK ORAL & FACIAL SURGERY - BURLEY; NPI #1356133870

Contact Information

CLARK ORAL & FACIAL SURGERY - BURLEY

1404 POMERELLE AVE STE A2
BURLEY, ID 83318-2013

Phone: 208-831-2901
Fax: 208-736-6249
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Oral and Maxillofacial Surgery	261QS0112X

Indicates primary specialty

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

NPI #	`1356133870`
LBN Legal business name	CLARK ORAL & FACIAL SURGERY - BURLEY
Authorized official	DURELLA HOLMES - (PRACTICE MANAGER)
Entity	Organization
Organization subpart ¹	Yes
Enumeration date	05/20/2025
Last updated	05/20/2025 - More than a year ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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