# ELISON ORAL AND MAXILLOFACIAL SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114255916
- **Authorized official:** DR. MARK TURNEY ELISON DMD (PRESIDENT)
- **Authorized official phone:** (208) 524-3200

## Contact information

- **Practice address:** 2588 CHANNING WAY, IDAHO FALLS, ID 83404-7515
- **Practice address phone:** (208) 524-3200
- **Mailing address:** 1655 CORONADO ST, IDAHO FALLS, ID 83404-7467
- **Mailing address phone:** (208) 529-0634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 12/07/2009
- **Last updated:** 12/07/2009