| NPI | 1326524851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE MARY MILNER VP Of Operations 208-376-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| 122300000X Dentist (Licence: UT 10868557-9921) | |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2020-06-16 |