Organization
RILEY J. HICKS D.D.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RILEY JARED HICKS D.D.S. (OWNER)
(208) 528-6000
Entity
Organization
Contact information
Practice address
3905 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 528-6000
(208) 528-6399
Mailing address
3905 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7596
(208) 528-6000
(208) 528-6399
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
3314
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0025480
—
MT
Enumeration date
08/23/2007
Last updated
08/23/2007
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