| NPI | 1093974446 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LOVE Financial Manager 208-472-7817 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D3443) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |