| NPI | 1194182725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON ROCHELLE GROVER Office Administrator 208-375-0192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |