| NPI | 1184006074 |
|---|---|
| Doing Business As | PINE STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | JOHN WILSON Owner 208-263-8535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-4649) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2025-09-19 |