| NPI | 1386899987 |
|---|---|
| Former Legal Business Name | BRADEN STAUTS DDS |
| Entity Type | Organization |
| Authorized Contact | BRADEN M STAUTS Owner 208-376-0567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-2083-PR) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |