Organization
TABLE ROCK ORAL SURGERY PLLC
Active
Other names
Table Rock Oral Surgery and Dental Implants
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY OBRIEN DDS, MD (OWNER)
(208) 412-0637
Entity
Organization
Contact information
Practice address
403 S 11TH ST STE 320, BOISE, ID 83702-6968
(208) 375-0191
Mailing address
403 S 11TH ST STE 320, BOISE, ID 83702-6968
(208) 375-0191
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
05/12/2021
Last updated
04/10/2024
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