| NPI | 1063783868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES C ALLEN President 208-354-8181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D3634) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: ID D1657) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2012-01-25 |