| NPI | 1114304250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P MALAN Dr 208-505-1946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: ID D4557OS) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2024-08-19 |