| NPI | 1275795395 |
|---|---|
| Doing Business As | SANDCREEK DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK ASAEL TALL President 208-525-4780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-2018) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2008-06-30 |