| NPI | 1154562783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LINEBERRY Orthodontist 208-658-9470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID d3184or) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-11 |