| NPI | 1043321110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE LEE SCHVANEVELDT Owner 208-734-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3515-OR) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-02-11 |