| Canyon County Oral Maxillofacial Surgery | |
|
4121 Clock Tower Ave Caldwell ID 83607-5006 | |
| (208) 459-7800 | |
| Not Available |
| Full Name | Canyon County Oral Maxillofacial Surgery |
|---|---|
| Speciality | Dentist |
| Location | 4121 Clock Tower Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Nicholas A Massoth (ORAL SURGEON) |
| Authorized Official Contact | 2084597800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon County Oral Maxillofacial Surgery 4121 Clock Tower Ave Caldwell ID 83607-5006 Ph: (208) 459-7800 | Canyon County Oral Maxillofacial Surgery 4121 Clock Tower Ave Caldwell ID 83607-5006 Ph: (208) 459-7800 |
| NPI Number | 1710184783 |
|---|---|
| Provider Enumeration Date | 07/02/2007 |
| Last Update Date | 07/10/2007 |
| Medicare PECOS PAC ID | 0547360125 |
|---|---|
| Medicare Enrollment ID | O20070711000759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710184783 | NPI | - | NPPES |
| 10149985 | Other | ID | REGENCE BLUE SHIELD |
| 1783151 | Other | ID | UNITED CONCORDIA |
| 6L859 | Other | ID | BLUE CROSS OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0106X | Dentist - Oral And Maxillofacial Pathology | D3848OS (Idaho) | Primary |
| Provider Name | Nicholas A Massoth |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1114957917 PECOS PAC ID: 2365442878 Enrollment ID: I20070108000226 |
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