| NPI | 1174631287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LYNN HIGGINSON Partner/Dentist 208-939-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3380) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID Drug ID #BH6399857) |
| 122300000X Dentist (Licence: ID D3878) | |
| 122300000X Dentist (Licence: ID Drug ID #BJ9304623) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2010-01-12 |