Individual
DR. TIMOTHY TRACY OBRIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
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
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-5013-OS
ID
Other
Enumeration date
04/11/2012
Last updated
06/03/2021
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