Idaho Falls Oral And Facial Surgery | |
3905 Washington Pkwy Idaho Falls ID 83404-7596 | |
(208) 528-6000 | |
Not Available |
Full Name | Idaho Falls Oral And Facial Surgery |
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Speciality | Dentist |
Location | 3905 Washington Pkwy, Idaho Falls, Idaho |
Authorized Official Name and Position | Gregory Mcgee (PRESIDENT) |
Authorized Official Contact | 2085211891 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Idaho Falls Oral And Facial Surgery 2184 Channing Way Ste 229 Idaho Falls ID 83404-8034 Ph: (505) 205-6618 | Idaho Falls Oral And Facial Surgery 3905 Washington Pkwy Idaho Falls ID 83404-7596 Ph: (208) 528-6000 |
NPI Number | 1477023778 |
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Provider Enumeration Date | 11/29/2018 |
Last Update Date | 07/24/2019 |
Medicare PECOS PAC ID | 5294061529 |
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Medicare Enrollment ID | O20190724003658 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477023778 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Provider Name | Gregory R Mcgee |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1891756367 PECOS PAC ID: 8729204607 Enrollment ID: I20190725000213 |
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