| NPI | 1255730370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS HUGUES Owner 208-238-1165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D3679PD) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |