| NPI | 1336313683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARNI PETERSON Office Manager 208-734-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1788) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |