| Elison Oral And Maxillofacial Surgery | |
|
2588 Channing Way Idaho Falls ID 83404-7515 | |
| (208) 524-3200 | |
| Not Available |
| Full Name | Elison Oral And Maxillofacial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 2588 Channing Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Mark Turney Elison (PRESIDENT) |
| Authorized Official Contact | 2085243200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Elison Oral And Maxillofacial Surgery 1655 Coronado St Idaho Falls ID 83404-7467 Ph: (208) 529-0634 | Elison Oral And Maxillofacial Surgery 2588 Channing Way Idaho Falls ID 83404-7515 Ph: (208) 524-3200 |
| NPI Number | 1114255916 |
|---|---|
| Provider Enumeration Date | 12/07/2009 |
| Last Update Date | 12/07/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114255916 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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