| NPI | 1225397409 |
|---|---|
| Other Name | ST. JUDE DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JASON BROWN Chief Executive Officer 208-899-9631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2020-06-17 |