| NPI | 1053705178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE MARY MILNER VP Of Operations 208-514-4739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D3315) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2015-03-26 |