| NPI | 1003010877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT ALAN PRATT Dentist 208-466-2458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3499) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-08-22 |