Organization
COEUR D' ALENE ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS G WALSH DDS (OWNER)
(208) 667-0655
Entity
Organization
Contact information
Practice address
1027 E SHERMAN AVE, COEUR D ALENE, ID 83814-4152
(208) 667-0655
(208) 667-5745
Mailing address
1027 E SHERMAN AVE, COEUR D ALENE, ID 83814-4152
(208) 667-0655
(208) 667-5745
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-1578-OS
ID
Other
Enumeration date
08/25/2011
Last updated
08/25/2011
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