Whitewater Woodriver Oral Surgery

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

Legal business name

WHITEWATER WOODRIVER ORAL SURGERY

Practice address

400 S Main St Ste 202
Hailey, ID 83333-8856

Phone

(208) 788-5308

NPI assigned

Aug 29, 2017

Last updated

Jul 21, 2022By 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

Marie E Berry

Title

Manager

Phone

(208) 788-5308

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790202810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S MAIN ST STE 202",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338856",
            "telephone_number": "208-788-5308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S MAIN ST STE 202",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338856",
            "telephone_number": "208-788-5308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITEWATER WOODRIVER ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-788-5308"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connor Joseph Wade
• Benton Wagner
• Britlynn Ward, LAC
• Michelle Ann Watkins, RDH
• Lawrence I Weiner, M.D.
• Brooke Nichole Wilkins, MYO THERAPIST
• Wood River Dental Care
• Wood River Family Medicine PLLC
• Wood River Family Medicine, PLLC
• Wood River Waldorf Methods School, a Public Charter School, Inc. (Syringa Mountain School)

• Oral and Maxillofacial Surgery Clinic/Center in Hailey, ID
• Providers in Hailey, 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 Jul 21, 2022; 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.