# PARKCENTER ORAL AND MAXILLOFACIAL SURGERY

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

## Provider details

- **NPI number:** 1811670631
- **Authorized official:** DR. STUART J RUPP DMD (OWNER)
- **Authorized official phone:** (208) 553-6813

## Contact information

- **Practice address:** 3190 E BARBER VALLEY DR, BOISE, ID 83716
- **Practice address phone:** (208) 715-5219
- **Practice address fax:** (208) 504-2771
- **Mailing address:** 3190 E BARBER VALLEY DR, BOISE, ID 83716
- **Mailing address phone:** (208) 715-5219
- **Mailing address fax:** (208) 504-2771

## 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:** 08/09/2023
- **Last updated:** 10/20/2023