| NPI | 1346870144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYON OYLER Owner 208-412-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2023-05-10 |