| NPI | 1083143739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY WALDEN BYBEE Dentist 208-478-1295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D1664) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-07-21 |