| NPI | 1376028324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LOUISE ROBISON Credentialing Coordinator 208-520-1514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |