| NPI | 1285806844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE MABEY Office Manager 208-233-7007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1599) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3894) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |