| NPI | 1073720009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT LYNN WILLIAMS Ownerpresident 208-734-3562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D1658) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2020-08-22 |