| NPI | 1417055062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD E LARSON President 208-939-1570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3551) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |