TABLE ROCK ORAL SURGERY PLLC; NPI #1487238689

Contact Information

TABLE ROCK ORAL SURGERY PLLC

403 S 11TH ST STE 320
BOISE, ID 83702-6968

Phone: 208-375-0191
Fax:
Website:

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

Indicates primary specialty

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NPI Profile & details for TABLE ROCK ORAL SURGERY PLLC

NPI Number	`1487238689`
LBN Legal business name	TABLE ROCK ORAL SURGERY PLLC
Authorized official	TIMOTHY OBRIEN - (OWNER)
Entity	Organization
Organization subpart ¹	No
Enumeration date	05/12/2021
Last updated	04/10/2024 - About 2 years 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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