| NPI | 1306973862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODNEY H HILLAM Owner President 208-524-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID 2019) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 918) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2020-08-22 |