| NPI | 1255263521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA LEE Billing Operations Manager 208-228-9210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2026-06-01 |
| Last Update Date | 2026-06-01 |