Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Table Rock Oral Surgery PLLC

Organization Oral and Maxillofacial Surgery Clinic/Center · NPI 1487238689

Table Rock Oral Surgery PLLC is an Oral and Maxillofacial Surgery Clinic/Center in Boise, Idaho. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

403 S 11th St Ste 320
Boise, ID 83702-6968
Phone: (208) 375-0191
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery Clinic/Center (primary) Taxonomy 261QS0112X

Record details

NPI number1487238689
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Timothy Obrien — Owner · (208) 412-0637
Other names Table Rock Oral Surgery And Dental Implants
NPI enumeratedMay 12, 2021
Last updated in NPPESApril 10, 2024
Certification dateApril 10, 2024
Mailing address403 S 11th St Ste 320, Boise, ID 83702-6968

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