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Organization
TETON OMS
Active
Organization
TETON OMS
Active
Other names
SNAKE RIVER SURGICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MAKELL CLAY (PRACTICE MANAGER)
(208) 932-4600
Entity
Organization
Contact information
Practice address
780 BRIDGEPORT DR, IDAHO FALLS, ID 83402-3370
(208) 932-4600
(208) 932-4601
Mailing address
780 BRIDGEPORT DR, IDAHO FALLS, ID 83402-3370
(208) 932-4600
(208) 932-4601
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Enumeration date
06/20/2025
Last updated
05/15/2026
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