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CANYON COUNTY ORAL MAXILLOFACIAL SURGERY INC NPI 1710184783


NPI Information

NPI: 1710184783
Provider Name: CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC

Doing Business As: CANYON COUNTY ORAL MAXILLOFACIAL SURGERY

Classification: Dentist - 1223P0106X
Entity Type: Organization

Specialization: Oral and Maxillofacial Pathology

Address:
4121 CLOCK TOWER AVE
CALDWELL, ID
ZIP 83607
Phone: (208) 459-7800
Get Directions

CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC is an oral and maxillofacial pathology dentist in Caldwell, ID. The provider is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC NPI is 1710184783. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Canyon County Oral Maxillofacial Surgery.

The provider's business location address is:

4121 CLOCK TOWER AVE
CALDWELL, ID
ZIP 83607-006
Phone: (208) 459-7800

The provider's authorized official is Nicholas A Massoth .
The authorized official title is Oral Surgeon and has the following contact phone number (208) 459-7800.

The enumeration date for this NPI number is 7/2/2007 and was last updated on 7/10/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
11223P0106XDentistOral and Maxillofacial PathologyD3848OSIDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
110149985OTHERIDAHOREGENCE BLUE SHIELD
26L859OTHERIDAHOBLUE CROSS OF ID
31783151OTHERIDAHOUNITED CONCORDIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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