| NPI | 1346501657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW STODDARD Sole Member 208-238-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-4149) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |