Organization
RUSSELL GUYMON ORTHODONTICS, PA
Active
Organization
RUSSELL GUYMON ORTHODONTICS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL J GUYMON DDS, MS (OWNER/ORTHODONTIST)
(208) 529-3500
Entity
Organization
Contact information
Practice address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 529-3500
Mailing address
333 S WOODRUFF AVE, IDAHO FALLS, ID 83401-4322
(208) 529-3500
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D-4402-OR
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10584378285
—
ID
Enumeration date
02/01/2012
Last updated
02/01/2012
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