| NPI | 1144653833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA A. POWELL Owner/President 208-344-2593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D1819) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |