Organization
ORAL SURGERY CENTER OF IDAHO, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DABELL (ORAL SURGEON)
(208) 884-0100
Entity
Organization
Contact information
Practice address
1550 N CRESTMONT DR STE G, MERIDIAN, ID 83642-2177
(208) 884-0100
(208) 884-4844
Mailing address
1550 N CRESTMONT DR STE G, MERIDIAN, ID 83642-2177
(208) 884-0100
(208) 884-4844
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
D-4099-OS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861645202
MY PERSONAL NPI NUMBER
—
Enumeration date
04/24/2013
Last updated
04/24/2013
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