| NPI | 1194097402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL J GUYMON Owner/Orthodontist 208-529-3500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-4402-OR) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-02-01 |