| NPI | 1124892773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL B SMITH Manager 208-870-6288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2024-11-21 |