| NPI | 1184399214 |
|---|---|
| Doing Business As | IDAHO PERIO |
| Entity Type | Organization |
| Authorized Contact | KIP KATSEANES Partner In Practice/Perodontist 843-530-4854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-08-11 |