| NPI | 1114255916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK TURNEY ELISON President 208-524-3200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2009-12-07 |