| NPI | 1275724304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA D JARDINE Office Administrator 208-376-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 3787) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2007-08-05 |