Timothy Tracy Obrien, DDS, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D-5013-OS Issued in ID

Practice address

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

Phone

(208) 375-0191

NPI assigned

Apr 11, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 6, 2025 through Oct 6, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Table Rock Oral Surgery PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Boise, ID
  • NPI 1487238689
  NPD Authorized official
• KHM Surgical Partnership

  • Oral and Maxillofacial Surgery Clinic/Center
  • Nampa, ID
  • NPI 1114304250
  NPD (past)
• Gardendale Oral Surgery, P.C.

  • Oral and Maxillofacial Surgery (Dentist)
  • Gardendale, AL
  • NPI 1336632561
  NPD (past)

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1487910733",
    "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": {
        "last_name": "OBRIEN",
        "first_name": "TIMOTHY",
        "middle_name": "TRACY",
        "name_prefix": "Dr.",
        "credential": "DDS, MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-11",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-5013-OS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ericka Obaitek
• Delaney Breanne Obaldia, MA, LPC
• Jennifer Obenshain, LCSW
• Larry Michael Oborn, PA-C
• Darin J Obrien, CRNA
• Kelly M Obringer, SLP
• Occupational Health Centers of Idaho LLC
• Lindsey Elizabeth Ochoa, PA-C
• Bridget Oconnell
• Monisha Oconnor

• Oral and Maxillofacial Surgery (Dentist) in Boise, ID
• Providers in Boise, 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 Jun 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.