CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC (NPI# 1710184783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710184783 |
| Entity Type | Organization |
| Organization Name | CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC |
| Other Organization Name | CANYON COUNTY ORAL MAXILLOFACIAL SURGERY |
| Practice Address |
4121 Clock Tower Ave Caldwell ID 83607-5006 |
| Practice Telephone | 2084597800 |
| Mailing Telephone | 2084597800 |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-10 |
| Authorized Official Name | NICHOLAS A MASSOTH (ORAL SURGEON) |
| Authorized Official Telephone | 2084597800 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
D3848OS | ID | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS OF ID | 6L859 | 01 |
| ID | UNITED CONCORDIA | 1783151 | 01 |
| ID | REGENCE BLUE SHIELD | 10149985 | 01 |
| Other Name | Type Code |
|---|---|
| Canyon County Oral Maxillofacial Surgery | Doing Business As Name - Organization |
| Street Address |
4121 CLOCK TOWER AVE |
| City | CALDWELL |
| State | ID |
| Zip Code | 83607-5006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114957917 | Nicholas A Massoth | Dentist | 4121 Clock Tower Ave, Caldwell, ID 83607-5006 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609106012 | Cordell Denton Nebeker | Dentist | 4111 Clocktower Ave., Caldwell, ID 83607 | 2010-01-07 |
| 1265677587 | Cory Shane Lindstrom | Chiropractor | 5216 E. Cleveland Blvd, Ste G, Caldwell, ID 83607 | 2008-12-16 |
| 1154533727 | Reality Based Services | Case Management | 24151 El Paso Rd, Caldwell, ID 83607 | 2007-05-04 |
| 1407998271 | Patrick L Waite | Dentist | 4101 Clock Tower Ave, Caldwell, ID 83607 | 2007-02-12 |
| 1104276377 | Jae's Transportaion LLC | Non-emergency Medical Transport (VAN) | 14310 Tara St, Caldwell, ID 83607-1431 | 2016-06-17 |
| 1417224460 | Rebecca Anne Tormey | Physical Therapist | 1202 Talon Ct, Caldwell, ID 83607-1579 | 2011-11-18 |
| 1174677603 | Vallivue School District #139 | Local Education Agency (LEA) | 5207 S Montana Ave, Caldwell, ID 83607-1583 | 2007-01-22 |
| 1679026447 | Kimberly Drewrey, Aprn, Np-c | Point of Service | 5210 Cleveland Blvd, Suite 140 #344, Caldwell, ID 83607-1796 | 2016-07-28 |
| 1619007903 | Mandy R Redmond | Specialist/Technologist | 1407 E Homedale Rd, Caldwell, ID 83607-1848 | 2007-03-06 |
| 1326263179 | Kira Ann Skroh | Specialist/Technologist | 1407 E Homedale Rd, Caldwell, ID 83607-1848 | 2007-04-16 |
| Find all providers in zip 83607 | ||||
| Taxonomy Code | 1223P0106X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Pathology |
| The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114957917 | Nicholas A Massoth | Dentist | 4121 Clock Tower Ave, Caldwell, ID 83607-5006 | 2006-07-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376593640 | Eric Webb Nelson | Dentist | 3003 W Main St Ste 130, Boise, ID 83702-2026 | 2006-05-10 |
| 1568095883 | Facial Trauma Associates Pllc | Dentist | 1000 N Curtis Rd Ste 103, Boise, ID 83706-1345 | 2020-02-14 |
| 1588868442 | Idaho Oral & Maxillofacial Surgery, PC | Dentist | 590 Falls Ave, Twin Falls, ID 83301-3314 | 2007-06-13 |
| 1376684175 | Scott M Blake | Dentist | 333 S Woodruff Ave, Idaho Falls, ID 83401-4322 | 2007-02-12 |
Please comment or provide details below to improve the information on CANYON COUNTY ORAL MAXILLOFACIAL SURGERY, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.