Organization
PALOUSE ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN WALLACE MORRISN D.M.D. (OWNER)
(208) 882-0331
Entity
Organization
Contact information
Practice address
2301 W A ST, SUITE A, MOSCOW, ID 83843-4042
(208) 882-0331
Mailing address
2301 W A ST, SUITE A, MOSCOW, ID 83843-4042
(208) 882-0331
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
D-3321-OS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164567913
NPI-PERSONAL
ID
Enumeration date
11/30/2009
Last updated
11/30/2009
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