| NPI | 1255503777 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SID ELLIS HEDGES Practice Administrator 208-232-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-1783) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |