Canyon County Oral Maxillofacial Surgery, Inc

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

D3848OS Issued in ID

Legal business name

CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC

Doing business as

Canyon County Oral Maxillofacial Surgery

Practice address

4121 Clock Tower Ave
Caldwell, ID 83607-5006

Phone

(208) 459-7800

NPI assigned

Jul 2, 2007

Last updated

Jul 10, 2007By 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

Nicholas A Massoth, DMDNPI 1114957917

Title

Oral Surgeon

Phone

(208) 459-7800

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Canyon County Oral Maxillofacial Surgery Doing business as

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.

• Nicholas A Massoth, D.M.D.

  • Oral and Maxillofacial Pathology Dentistry
  • Caldwell, ID
  • NPI 1114957917
  NPD Authorized official

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1710184783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075006",
            "telephone_number": "208-459-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 CLOCK TOWER AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836075006",
            "telephone_number": "208-459-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "MASSOTH",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "208-459-7800",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "ID",
            "license": "D3848OS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1783151",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "10149985",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID",
            "identifier": "6L859",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon County Oral Maxillofacial Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Afton Campbell Sr, LMSW
• Scott Duncan Campbell
• Raul Campos III
• Canyon Counseling Center Inc.
• Canyon County Ambulance District
• Canyon Creek Developmental Services
• Canyon Creek Developmental Services
• Canyon Small Animal Hospital
• Canyon West of Cascadia, LLC
• Christopher Mark Card, OD

• Oral and Maxillofacial Pathology Dentistry in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Oral and Maxillofacial Pathology Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.