Idaho Oral Surgery Pllc
NPI #1912172958 in Fruitland, Idaho
Provider Information
- NPI Number
- 1912172958
- Entity Type
- Organization
- Organization Name
- Idaho Oral Surgery Pllc
- Primary Specialty
- Exclusive Provider Organization
- Enumeration Date
- Apr 29, 2008
- Last Updated
- Apr 19, 2010
Practice Location
Authorized Official
- Name
- RYAN DAVID HILLAM, DDS
- Title
- SURGEON
- Phone
- (208) 452-4808
Specialties & Taxonomy Codes
| Specialty |
|---|
| Exclusive Provider Organization |
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