| NPI | 1336220144 |
|---|---|
| Former Legal Business Name | BETHEL DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | ROBERT ORLO STEVENS Dentist Owner 208-375-5656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D1807) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-05-13 |