| NPI | 1013757830 |
|---|---|
| Doing Business As | IDAHO ORTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE DASCH Director Of Cred And Prov Rel 504-638-0303 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |