Organization
ELISON ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK TURNEY ELISON DMD (PRESIDENT)
(208) 524-3200
Entity
Organization
Contact information
Practice address
2588 CHANNING WAY, IDAHO FALLS, ID 83404-7515
(208) 524-3200
Mailing address
1655 CORONADO ST, IDAHO FALLS, ID 83404-7467
(208) 529-0634
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
12/07/2009
Last updated
12/07/2009
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