| NPI | 1205120441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD J JOHNSON Owner 208-667-4551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1677) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2018-06-22 |