Provider Demographics
NPI:1184836249
Name:TOENJES BRIZZEE & ORME PA
Entity Type:Organization
Organization Name:TOENJES BRIZZEE & ORME PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RF
Authorized Official - Last Name:TOENJES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-624-3757
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0567
Mailing Address - Country:US
Mailing Address - Phone:208-624-3757
Mailing Address - Fax:208-624-4703
Practice Address - Street 1:305 E 5TH N
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-1626
Practice Address - Country:US
Practice Address - Phone:208-624-3757
Practice Address - Fax:208-624-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8073966Medicaid