Healthcare Provider Details

I. General information

NPI: 1497142350
Provider Name (Legal Business Name): OXFORD DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 OXFORD DR
IDAHO FALLS ID
83401-4203
US

IV. Provider business mailing address

749 OXFORD DR
IDAHO FALLS ID
83401-4203
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0420
  • Fax:
Mailing address:
  • Phone: 208-529-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-4623
License Number StateID

VIII. Authorized Official

Name: DR. ANDREW N BITTER
Title or Position: DENTIST
Credential: DDS
Phone: 208-529-0420