NPI 1912172958

Idaho Oral Surgery PLLC

Organisation Exclusive Provider Organization Fruitland, ID

Practice location

Address: 1820 N Whitley Dr, Fruitland, ID 83619-2163
Phone: (208) 452-4808
Fax: (208) 452-6617

Authorised official

Name: Ryan David Hillam
Title: Surgeon
Phone: (208) 452-4808

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence D3949OS (ID)

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Registry record

NPI: 1912172958
Entity type: Organization
NPI issued: 29 Apr 2008
Record last updated: 19 Apr 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.