| NPI | 1407957897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRBY L CLENDENON President 208-454-9217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1836) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-08-22 |