| NPI | 1275999872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATALY PENUELAS Office Manager 208-680-0186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D-4109) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-01-12 |