| NPI | 1194369371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORIE A HURST Bookkeeper 208-283-7634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-10-31 |