| NPI | 1225578768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HARVEY JAMES CLARK Owner 208-336-8478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-1699) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-03-02 |