Parkcenter Oral and Maxillofacial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

PARKCENTER ORAL AND MAXILLOFACIAL SURGERY

Practice address

3190 E Barber Valley Dr
Boise, ID 83716

Phone

(208) 715-5219

Fax

(208) 504-2771

NPI assigned

Aug 9, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Stuart J Rupp, DMD

Title

Owner

Phone

(208) 553-6813

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1811670631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 E BARBER VALLEY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83716",
            "telephone_number": "208-715-5219",
            "fax_number": "208-504-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 E BARBER VALLEY DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83716",
            "telephone_number": "208-715-5219",
            "fax_number": "208-504-2771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKCENTER ORAL AND MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-09",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "RUPP",
        "authorized_official_first_name": "STUART",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-553-6813",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark G Parent, MD
• Karrie Ann Pargman
• Grace Macall Pariseau
• Alyssa Lejeana Parish
• Park Center Foot and Ankle
• Parkcenter Smiles LLC
• Carolyn Parker
• Johnna L Parker, M.A.,CCC-SLP
• Karen Patrice Parker, MS
• Kayla Rae Parker, LMSW

• 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 Oct 20, 2023; 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.