| Treasure Valley Oral And Facial Surgery Pllc | |
|
1000 N. Curtis Rd Suite 103 Boise ID 83706 | |
| (208) 343-0909 | |
| (208) 343-6282 |
| Full Name | Treasure Valley Oral And Facial Surgery Pllc |
|---|---|
| Speciality | Dentist |
| Location | 1000 N. Curtis Rd, Boise, Idaho |
| Authorized Official Name and Position | Cole W Anderson (OWNER) |
| Authorized Official Contact | 2088611689 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Treasure Valley Oral And Facial Surgery Pllc 1000 N. Curtis Rd Suite 103 Boise ID 83706 Ph: (208) 343-0909 | Treasure Valley Oral And Facial Surgery Pllc 1000 N. Curtis Rd Suite 103 Boise ID 83706 Ph: (208) 343-0909 |
| NPI Number | 1013274661 |
|---|---|
| Provider Enumeration Date | 04/20/2012 |
| Last Update Date | 09/06/2017 |
| Medicare PECOS PAC ID | 5799936597 |
|---|---|
| Medicare Enrollment ID | O20121102000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013274661 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D4410 (Idaho) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (Idaho) | Primary |
| Provider Name | Cole W Anderson |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1316175458 PECOS PAC ID: 6507017308 Enrollment ID: I20121102000343 |
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