| NPI | 1083784946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS C. CUSIMANO Orthodontist 208-467-4362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D-3247-OR) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2015-04-02 |