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

Q: What is Table Rock Oral Surgery PLLC's NPI number?

The NPI number for Table Rock Oral Surgery PLLC is 1487238689. It was assigned to this organization in the NPPES registry on May 12, 2021. The provider is doing business as Table Rock Oral Surgery And Dental Implants.

Q: What is Table Rock Oral Surgery PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Oral and Maxillofacial Surgery, with taxonomy code 261QS0112X.

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: August 16, 2026.

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

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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 NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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 NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Table Rock Oral Surgery PLLC's NPI number?

The NPI number for Table Rock Oral Surgery PLLC is 1487238689. It was assigned to this organization in the NPPES registry on May 12, 2021. The provider is doing business as Table Rock Oral Surgery And Dental Implants.

Where is Table Rock Oral Surgery PLLC located?

Table Rock Oral Surgery PLLC is located at 403 S 11th St Ste 320, Boise, ID 83702. The listed phone number is (208) 375-0191.

What is Table Rock Oral Surgery PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Oral and Maxillofacial Surgery, with taxonomy code 261QS0112X.

When was this NPI record last updated?

The NPPES record for Table Rock Oral Surgery PLLC was last updated on April 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.