| NPI | 1295994408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEE BEHLER Secretary 208-983-0105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3987) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3978) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |