| NPI | 1174636963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG GUYMON Co Owner 208-898-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D3295OR) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-22 |