# ID OMS SPECIALTY DENTAL SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ID OMS SPECIALTY DENTAL SERVICES, PLLC
- **Other names:** Boise Oral Surgery & Implant Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467218552
- **Legal business name:** ID OMS SPECIALTY DENTAL SERVICES, PLLC
- **Authorized official:** CHARLOTTE DASCH (DIRECTOR OF CREDENTIALING AND PR)
- **Authorized official phone:** (615) 678-0759

## Contact information

- **Practice address:** 7910 W USTICK RD, BOISE, ID 83704-5850
- **Practice address phone:** (208) 322-5522
- **Mailing address:** 1610 54TH AVE N STE 205, NASHVILLE, TN 37209-1442
- **Mailing address phone:** (615) 678-0759

## 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:** 02/26/2024
- **Last updated:** 02/26/2024