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Table Rock Oral Surgery PLLC — NPI 1487238689, Boise, ID | NPI Central

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NPI 1487238689

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Table Rock Oral Surgery PLLC

NPI 1487238689 · Oral and Maxillofacial Surgery Clinic/Center · Boise, ID

Provider details

NPI number: 1487238689
Entity type: Organization
Primary specialty: Oral and Maxillofacial Surgery Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Timothy Obrien, Owner(208) 412-0637

Specialties & taxonomies

Oral and Maxillofacial Surgery Clinic/CenterPrimary261QS0112X
Ambulatory Health Care Facilities

Practice location

403 S 11th St Ste 320

Boise, ID 83702-6968

Phone: (208) 375-0191

Approximate (ZIP-level) locationGet directions

More ID providers

Mailing address

403 S 11th St Ste 320

Boise, ID 83702-6968

Other names (DBA / former)

Doing business as: Table Rock Oral Surgery and Dental Implants

Registry dates

Enumerated: 2021-05-12
Last updated: 2024-04-10
Certified: 2024-04-10

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.