Table Rock Oral Surgery PLLC

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

TABLE ROCK ORAL SURGERY PLLC

Doing business as

Table Rock Oral Surgery and Dental Implants

Practice address

403 S 11TH St Ste 320
Boise, ID 83702-6968

Phone

(208) 375-0191

NPI assigned

May 12, 2021

Organization subpart

No

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

Authorized official

Name

Timothy Obrien, DDS, MDNPI 1487910733

Title

Owner

Phone

(208) 412-0637

Specialties & licenses 1

Addresses

Other names 1

• Table Rock Oral Surgery and Dental Implants Doing business as

Electronic endpoints 1

Locations

Practitioners 2

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

• Timothy Tracy Obrien, DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1487910733
  NPD Authorized official
• J Brett Comstock, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Boise, ID
  • NPI 1710938733
  NPD (past)

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

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1487238689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 S 11TH ST STE 320",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026968",
            "telephone_number": "208-375-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 S 11TH ST STE 320",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026968",
            "telephone_number": "208-375-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TABLE ROCK ORAL SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-12",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "OBRIEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-412-0637",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@tablerockoralsurgery.com",
            "affiliation": "N",
            "endpointDescription": "E-Mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "403 S 11th St Ste 320",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837026968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Table Rock Oral Surgery and Dental Implants",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Calan Szmyd, MS, LCGC
• Summer E Szumski, DO
• Jessica Lee Szwec, PA-C
• Laura Ruth Szymanski, NP-C
• Majda Tabakovic, FNP
• Table Rock Physical Therapy
• Kendall Tacchini
• John Taffin
• Trevor E Tafoya, D.M.D.
• Haley Taggart

• Oral and Maxillofacial Surgery Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.