| NPI | 1215395025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDON JAMES SWENSON Manager 208-649-5721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-02-27 |