| NPI | 1235398520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH LYONS Office Manager 208-888-4481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3421) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |