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TABLE ROCK ORAL SURGERY AND DENTAL IMPLANTS
NPI 1487238689
Clinic/Center - Oral and Maxillofacial Surgery in Boise, ID

Active since May 12, 2021
403 S 11TH ST STE 320, BOISE, ID 83702(208) 375-0191 Get Directions Write a Review

NPPES record last updated: April 10, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 10, 2024, May 12, 2021 (2 updates tracked since 2021).

About Table Rock Oral Surgery And Dental Implants NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TABLE ROCK ORAL SURGERY AND DENTAL IMPLANTS (NPI 1487238689) is a healthcare organization registered as an oral and maxillofacial surgery in Boise, Idaho and active in the NPI registry since May 2021. The organization lists Timothy Obrien, Owner, as its authorized official.

NPPES Registry Identity

NPI1487238689
Entity TypeOrganization
Primary Taxonomy261QS0112X
Legal Business NameTABLE ROCK ORAL SURGERY PLLC
Location Address403 S 11TH ST STE 320Boise, ID 83702-6968
Mailing Address403 S 11th St Ste 320Boise, ID 83702-6968 · (208) 375-0191
Phone(208) 375-0191
Organization SubpartNo
Authorized OfficialTimothy ObrienOwner · (208) 412-0637
Enumeration DateMay 12, 2021
Last NPPES UpdateApril 10, 20242 updates tracked since enumeration
NPPES CertifiedApril 10, 2024
✔ NPI 1487238689 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Oral and Maxillofacial SurgeryAmbulatory Health Care Facilities
Taxonomy Code261QS0112X
Definition

An oral and maxillofacial surgery clinic or center specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

403 S 11TH ST STE 320, Boise, ID 83702
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Other Names 1

Doing Business AsTable Rock Oral Surgery And Dental Implants

Other Providers at the Same Location


The following 1 provider is registered at the same or a nearby location.

DR. TIMOTHY TRACY OBRIEN DDS, MD
Dentist (Oral and Maxillofacial Surgery)
403 S 11TH ST STE 320
BOISE, ID 83702
Ada County (208) 375-0191

Frequently Asked Questions

What is TABLE ROCK ORAL SURGERY PLLC's NPI number?

The NPI number assigned to this healthcare provider is 1487238689, enumerated as an "organization" on May 12, 2021.

Where is the provider located?

The provider is located at 403 S 11TH ST STE 320 BOISE, ID 83702 and the phone number is (208) 375-0191.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QS0112X and a focus in Oral and Maxillofacial Surgery.