NPI | 1043321110 |
---|---|
Former Legal Business Name | ORTHODONTIC SPECIALISTS OF MAGIC VALLEY |
Entity Type | Organization |
Authorized Contact | SHANE L. SCHVANEVELDT Doctor Owner 208-734-4600 |
Organization Subpart ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3515-OR) |
Enumeration Date | 2006-08-31 |
Last Update Date | 2025-09-22 |