| NPI | 1013021575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JAMES MCCALL President 208-935-2143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID C128433) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-08-22 |