NPI age
5 years
Enumerated 2021-05-12
● Active Type 2 · Organization
Table Rock Oral Surgery Pllc
Table Rock Oral Surgery Pllc is 1 of 11 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Obrien
Owner
Last NPPES update
2024-04-10
Source: monthly bulk 2026-05
How this organization compares
Across 11 active clinic/center providers in Idaho.
NPI age
5 years
↓ 3 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2021 → 2026
2021-05Enumerated in NPPES
2021
2026
Where they practice
Primary practice location
403 S 11th St Ste 320
Boise, ID 837026968
Mailing address
403 S 11th St Ste 320
Boise, ID 837026968
Authorized official
Timothy Obrien, DDS, MD
Owner
📞 2084120637
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Timothy Obrien, DDS, MD Dentist NPI 1487910733
Specialties
-
Clinic/Center PrimaryThe specialty of dentistry which includes 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.
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Table Rock Oral Surgery and Dental Implants
Practice context
Multi-provider organization. 1 individual provider on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.