Facial Oral and Dental Implant Surgery Associates, Inc.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D-4057 Issued in ID

Legal business name

FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES, INC.

Practice address

3326 4TH St Ste 2
Lewiston, ID 83501-4455

Phone

(208) 743-1640

Fax

(208) 743-1643

NPI assigned

Nov 10, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephen Wilford Holm, DMDNPI 1295993145

Title

Owner

Phone

(208) 743-1640

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Oral and Facial Surgery Doing business as

Tax ID family

Facial Oral and Dental Implant Surgery Associates Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Facial Oral and Dental Implant Surgery Associates, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Pullman, WA
  • NPI 1730638180
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stephen W Holm, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lewiston, ID
  • NPI 1295993145
  NPD (past) Authorized official
• Sherdon Wade Cordova, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Saint Joseph, IL
  • NPI 1568594638
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1003060591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3326 4TH ST STE 2",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-1640",
            "fax_number": "208-743-1643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3326 4TH ST STE 2",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014455",
            "telephone_number": "208-743-1640",
            "fax_number": "208-743-1643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FACIAL ORAL AND DENTAL IMPLANT SURGERY ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-10",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "HOLM",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "WILFORD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-743-1640",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-4057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808116400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO SMILES",
            "identifier": "9212066",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral and Facial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Essential Womens Wellness
• Daniel Nile Evans, O.D.
• Geni L Evans, NP
• Russell L Evans, PA-C
• Doyle Gary Evers, D.D.S.
• Robert Kenneth Fairbanks, M.D.
• Amber Farance, PA-C
• Klarin Leann Fausett, COTA/L
• James Forrest Fauver
• Marie Ferrigno

• Oral and Maxillofacial Surgery (Dentist) in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Oral and Maxillofacial Surgery (Dentist) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.