| NPI | 1306005236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD E FELLOWS Owner 208-237-4357 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3406) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |