Provider Demographics
NPI:1497142350
Name:OXFORD DENTAL CARE
Entity Type:Organization
Organization Name:OXFORD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:N
Authorized Official - Last Name:BITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-529-0420
Mailing Address - Street 1:749 OXFORD DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4203
Mailing Address - Country:US
Mailing Address - Phone:208-529-0420
Mailing Address - Fax:
Practice Address - Street 1:749 OXFORD DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4203
Practice Address - Country:US
Practice Address - Phone:208-529-0420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-46231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty