| NPI | 1366601734 |
|---|---|
| Other Name | MODERN DENTAL |
| Entity Type | Organization |
| Authorized Contact | MICHELLE D RYAN Office Manager 208-333-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3273) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2011-09-06 |