| NPI | 1013479542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG R SMITH Owner 208-343-1393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-04-03 |