NPI | 1194980417 |
---|---|
Entity Type | Organization |
Authorized Contact | WARREN R WILLIS Co Owner 208-887-9000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID DH-1189) |
Enumeration Date | 2008-07-25 |
Last Update Date | 2008-07-25 |