| NPI | 1407483027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DON R COOK Owner 208-377-8078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2022-10-24 |