| NPI | 1124346499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TULLER Dentist 208-322-5655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D2065) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |