| NPI | 1114072154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN J TINGEY Dentist 208-734-4111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4037) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-08-11 |