OrganizationActive
Eagle Oral Surgery and Dental Implant Center PLLC
NPI 1780074864 · Oral and Maxillofacial Surgery (Dentist) · Eagle, ID
Provider details
- NPI number
- 1780074864
- Entity type
- Organization
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)Dental Providers
- Organization subpart
- No
- Authorized official
- Jeremy Hixson, Owner/Provider(208) 451-6584
- License
- D-4617-OS (ID)
Specialties & taxonomies
Dental Providers
Practice location
197 W State St
Eagle, ID 83616-4959
Phone: (208) 995-2865
Approximate (ZIP-level) locationGet directions
Mailing address
197 W State St
Eagle, ID 83616-4959
Registry dates
- Enumerated
- 2015-01-28
- Last updated
- 2015-01-28
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.