Organization
LEGACY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLIVER ONEAL THUERNAGLE DMD (DENTIST)
(208) 523-0840
Entity
Organization
Contact information
Practice address
1685 PANCHERI DR, IDAHO FALLS, ID 83402-3169
(208) 523-0840
(208) 523-0921
Mailing address
4935 JUPITER HILLS DR, IDAHO FALLS, ID 83401-6344
(208) 528-7537
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3902
ID
Other
Enumeration date
07/28/2006
Last updated
08/22/2020
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