| NPI | 1134136286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LYNN GOLD President 208-884-5556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3489-OR) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2020-08-22 |