| NPI | 1356465660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDEE L CHAPPLE Administrator 208-523-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-1297) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-3271) |
| 1223G0001X Dentist, General Practice (Licence: ID D-3063) | |
| 1223G0001X Dentist, General Practice (Licence: ID D-1890) | |
| 1223G0001X Dentist, General Practice (Licence: ID D4138) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2014-02-03 |