IDAHO CENTER FOR ORAL AND FACIAL SURGERY; NPI #1558675298

Contact Information

IDAHO CENTER FOR ORAL AND FACIAL SURGERY

177 VISTA DR
POCATELLO, ID 83201-5824

Phone: 208-232-0232
Fax: 208-232-2044
Website:

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

Indicates primary specialty

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NPI Profile & details for IDAHO CENTER FOR ORAL AND FACIAL SURGERY

NPI # 1558675298

LBN Legal business name IDAHO CENTER FOR ORAL AND FACIAL SURGERY

Authorized official JEFFREY DABELL - (SURGEON)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/05/2010

Last updated 11/30/2010 - About 16 years ago

Identifiers

License #

D-4276-OS

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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