National Provider Identifier Database

TABLE ROCK ORAL SURGERY PLLC
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

TABLE ROCK ORAL SURGERY PLLC
403 S 11TH ST STE 320
BOISE, ID83702-6968
Phone: 208-375-0191
Fax:
Website:
Specialty Taxonomy Code
* Oral and Maxillofacial Surgery 261QS0112X

* Indicates primary specialty

NPI Profile & details for TABLE ROCK ORAL SURGERY PLLC

NPI Number 1487238689
Legal business name
LBN
TABLE ROCK ORAL SURGERY PLLC
Authorized official TIMOTHY OBRIEN - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 05/12/2021
Last updated 04/10/2024 - About 2 years 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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