| NPI | 1346572435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAMIE LUND Office Manager 208-884-0100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: ID B-3163) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |