MEDICARE: DR. VAL HEBER BINGHAM D.D.S., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	D-3960-EN	ID

General Provider Information

NPI Number	:	1588757223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAL HEBER BINGHAM D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3387 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404
Country	:	US
Telephone Number	:	208-227-0382
Fax Number	:	208-227-0384

Provider Business Practice Location Address
First Line	:	3387 MERLIN DR
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404
Country	:	US
Telephone Number	:	208-227-0382
Fax Number	:	208-227-0384

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/24/2008

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