| NPI | 1114161551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA HOLMES Office Manager 208-664-0844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-1861-OS) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |