| NPI | 1093914210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN M CROWLEY JARVIS Dentist 208-888-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3995) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2008-06-18 |