| NPI | 1295991669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMON ASHLEY ANDERSON Owner 208-376-2721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3787) |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2008-08-05 |