| Eagle Oral Surgery And Dental Implant Center Pllc | |
|
197 W State St Eagle ID 83616-4959 | |
| (208) 995-2865 | |
| Not Available |
| Full Name | Eagle Oral Surgery And Dental Implant Center Pllc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 197 W State St, Eagle, Idaho |
| Authorized Official Name and Position | Jeremy L Hixson (OWNER/PROVIDER) |
| Authorized Official Contact | 2084516584 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eagle Oral Surgery And Dental Implant Center Pllc 197 W State St Eagle ID 83616-4959 Ph: (208) 995-2865 | Eagle Oral Surgery And Dental Implant Center Pllc 197 W State St Eagle ID 83616-4959 Ph: (208) 995-2865 |
| NPI Number | 1780074864 |
|---|---|
| Provider Enumeration Date | 01/28/2015 |
| Last Update Date | 01/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780074864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | D-4617-OS (Idaho) | Primary |
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