OrganizationActive
Idaho Oral Surgery PLLC
NPI 1912172958 · Exclusive Provider Organization · Fruitland, ID
Provider details
- NPI number
- 1912172958
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Ryan Hillam, Surgeon(208) 452-4808
- License
- D3949OS (ID)
Specialties & taxonomies
Managed Care Organizations
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1820 N Whitley Dr
Fruitland, ID 83619-2163
Phone: (208) 452-4808
Fax: (208) 452-6617
Street-level locationGet directions
Mailing address
1820 N Whitley Dr
Fruitland, ID 83619-2163
Other names (DBA / former)
- Former legal business name
- Center for Oral & Facial Surgery
Registry dates
- Enumerated
- 2008-04-29
- Last updated
- 2010-04-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.