Whitewater Woodriver Oral Surgery

NPI #1790202810 in Hailey, Idaho

Provider Information

NPI Number: 1790202810
Entity Type: Organization
Organization Name: Whitewater Woodriver Oral Surgery
Primary Specialty: Clinic/Center - Oral and Maxillofacial Surgery
Enumeration Date: Aug 29, 2017
Last Updated: Jul 21, 2022

Practice Location

Address: 400 S MAIN ST STE 202
City: Hailey
State: Idaho
ZIP Code: 83333-8856
Phone: (208) 788-5308

Authorized Official

Name: MARIE E BERRY
Title: MANAGER
Phone: (208) 788-5308

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	261QS0112X	Primary

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