| NPI | 1003116542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF TULLER Owner/Dentist 208-343-7271 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-2065) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2010-11-01 |