| NPI | 1215102439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIZ JOHN Office Manager 208-237-6848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D1967) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D3808) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |