| NPI | 1255590105 |
|---|---|
| Doing Business As | IDAHO DENTAL WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | GUY MATTHEW HANSON President 208-375-1012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D1850) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |