| NPI | 1023296605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD S BARLOW President 208-777-9331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-3781) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4050) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2008-02-05 |