| NPI | 1083873400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G PETERSON Dentist 208-375-0185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 3921) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |