| NPI | 1124534433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN A CATMULL Owner 208-436-4747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4143) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2023-09-27 |