| NPI | 1073805735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MICHAEL KOWALCZYK Dentist 208-342-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3689) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2011-05-12 |