| Facial & Oral Surgery Associates, Inc. | |
|
165 N 14th Ave Pocatello ID 83201-4146 | |
| (208) 232-2807 | |
| (208) 232-8118 |
| Full Name | Facial & Oral Surgery Associates, Inc. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 165 N 14th Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Wende Stuart (OFFICE ADMINISTRATOR) |
| Authorized Official Contact | 2082322807 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Facial & Oral Surgery Associates, Inc. Po Box 6033 Pocatello ID 83205-6033 Ph: (208) 232-2807 | Facial & Oral Surgery Associates, Inc. 165 N 14th Ave Pocatello ID 83201-4146 Ph: (208) 232-2807 |
| NPI Number | 1649453275 |
|---|---|
| Provider Enumeration Date | 12/05/2007 |
| Last Update Date | 06/16/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649453275 | NPI | - | NPPES |
| 190005336 | Other | ID | RAILROAD MEDICARE |
| 190009031 | Other | ID | RAILROAD MEDICARE |
| 805112100 | Medicaid | ID | |
| 805112200 | Medicaid | ID | |
| 805177600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D3016 (Idaho) | Primary |
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