| NPI | 1114069903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARIN R MOOSO Dentist 208-455-9498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3237) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-08-22 |