| NPI | 1356693915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN MICHAEL WHITNEY President 208-664-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: ID D4420PE) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: ID D4420EN) |
| Enumeration Date | 2012-10-07 |
| Last Update Date | 2012-10-07 |