Individual
THEODORE JAMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2677 E 17TH ST STE 600, AMMON, ID 83406-6619
(208) 705-9652
Mailing address
2677 E 17TH ST STE 600, AMMON, ID 83406-6619
(208) 705-9652
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D-5258
ID
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS041404
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2017
Last updated
01/12/2024
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