| NPI | 1366602773 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE CLARK Office Manager 208-454-0473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID d-1857) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |