| NPI | 1144720103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES G DRAKE Doctor/Partner 208-524-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3723) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D3203) |
| 1223G0001X Dentist General Practice (Licence: ID D1989) | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2018-02-16 |