| NPI | 1053584284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R BAILEY Owner 208-344-9115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D3165/M6325) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2012-01-23 |