Organization
IDAHO ORAL SURGERY PLLC
Active
Other names
CENTER FOR ORAL & FACIAL SURGERY
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DAVID HILLAM DDS (SURGEON)
(208) 452-4808
Entity
Organization
Contact information
Practice address
1820 N WHITLEY DR, FRUITLAND, ID 83619-2163
(208) 452-4808
(208) 452-6617
Mailing address
1820 N WHITLEY DR, FRUITLAND, ID 83619-2163
(208) 452-4808
(208) 452-6617
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
D3949OS
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241342
—
OR
05
—
807651700
—
ID
Enumeration date
04/29/2008
Last updated
04/19/2010
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