| NPI | 1073750469 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J AGNETTA Owner 208-323-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D-1766-OR) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: ID D-3856) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2009-01-07 |