| NPI | 1164539383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY D DELUNA Office Manager 208-733-4515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3263) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4582) |
| 1223G0001X Dentist, General Practice (Licence: ID D4137) | |
| 122300000X Dentist (Licence: ID D4141) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2015-05-21 |