| NPI | 1225379654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TODD MCMINN Orthodontist 208-678-2738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2013-03-11 |
| Last Update Date | 2013-03-11 |