| NPI | 1003144114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN O JOHNSON President 208-522-8854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1853) |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2015-05-20 |