NPI | 1164615084 |
---|---|
Entity Type | Organization |
Authorized Contact | RILEY JARED HICKS Owner 208-528-6000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID 3314) |
Enumeration Date | 2007-08-23 |
Last Update Date | 2007-08-23 |