| NPI | 1336311612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN WARD Owner/Doctor 208-734-4314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D-1385-OR) |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2008-03-27 |