Idaho Center for Oral and Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

D-4276-OS Issued in ID

Legal business name

IDAHO CENTER FOR ORAL AND FACIAL SURGERY

Practice address

177 Vista Dr
Pocatello, ID 83201-5824

Phone

(208) 232-0232

Fax

(208) 232-2044

NPI assigned

Aug 5, 2010

Last updated

Nov 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey C Dabell, DMD, MD

Title

Surgeon

Phone

(208) 232-0232

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen W Holm, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lewiston, ID
  • NPI 1295993145
  NPD (past)

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1558675298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 VISTA DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015824",
            "telephone_number": "208-232-0232",
            "fax_number": "208-232-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 VISTA DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015824",
            "telephone_number": "208-232-0232",
            "fax_number": "208-232-2044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO CENTER FOR ORAL AND FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-05",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "DABELL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SURGEON",
        "authorized_official_telephone_number": "208-232-0232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "D-4276-OS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Hurlbut
• Stephen Charles Hurley, PHARM.D.
• Yesenia Ruby Ibarra, LCSW
• Id SDS II PLLC (Idaho Orthodontics)
• Id Specialty Dental Services, PLLC (Idaho Orthodontics)
• Idaho Dept of Health & Welfare Esc Region 6
• Idaho Dept of Health & Welfare Itp Region 6
• Idaho Dept of Health & Welfare Reg 6 Amh Clinic Poc
• Idaho Dept of Health & Welfare Reg 6 Amh PSR Poc
• Idaho Dept of Health & Welfare Reg 6 CM

• Oral and Maxillofacial Surgery Clinic/Center in Pocatello, ID
• Providers in Pocatello, 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 Nov 30, 2010; 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.