Organization
WHITEWATER WOODRIVER ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIE E BERRY (MANAGER)
(208) 788-5308
Entity
Organization
Contact information
Practice address
400 S MAIN ST STE 202, HAILEY, ID 83333-8856
(208) 788-5308
Mailing address
400 S MAIN ST STE 202, HAILEY, ID 83333-8856
(208) 788-5308
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
08/29/2017
Last updated
07/21/2022
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