| NPI | 1205083714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE R PETERSON President 208-322-8877 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3654) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2008-08-26 |