| NPI | 1326395385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDEE L CHAPPLE Office Administrator 208-523-5400 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3063) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4138) |
| 1223G0001X Dentist, General Practice (Licence: ID D1890) | |
| 1223G0001X Dentist, General Practice (Licence: ID D4036) | |
| 1223G0001X Dentist, General Practice (Licence: ID D4369) | |
| 1223G0001X Dentist, General Practice (Licence: ID D1608) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-08-24 |