| NPI | 1023398716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS G WALSH Owner 208-667-0655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-1578-OS) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2011-08-25 |