| NPI | 1124468319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CURTIS TRENT STODDARD President 208-360-5991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1352) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2013-07-02 |