| NPI | 1245560945 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY DEAN JENKINS President 208-881-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-4216) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2023-10-20 |