| Riley J. Hicks D.d.s., P.a. | |
|
3905 Washington Pkwy Idaho Falls ID 83404-7596 | |
| (208) 528-6000 | |
| (208) 528-6399 |
| Full Name | Riley J. Hicks D.d.s., P.a. |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 3905 Washington Pkwy, Idaho Falls, Idaho |
| Authorized Official Name and Position | Riley Jared Hicks (OWNER) |
| Authorized Official Contact | 2085286000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Riley J. Hicks D.d.s., P.a. 3905 Washington Pkwy Idaho Falls ID 83404-7596 Ph: (208) 528-6000 | Riley J. Hicks D.d.s., P.a. 3905 Washington Pkwy Idaho Falls ID 83404-7596 Ph: (208) 528-6000 |
| NPI Number | 1164615084 |
|---|---|
| Provider Enumeration Date | 08/23/2007 |
| Last Update Date | 08/23/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164615084 | NPI | - | NPPES |
| 0025480 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 3314 (Idaho) | Primary |
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