| NPI | 1114452836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN WARD Owner 208-918-5622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1353) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2017-05-01 |