| NPI | 1356500318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW L KOOYMAN Owner 208-884-8858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3565) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |