| NPI | 1265605596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS J MICHAELSON Owner 208-678-3265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID 67D1497) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |