| NPI | 1437660388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROARKE JAKE MILLER Owner, Managing Member 208-906-6977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3742) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2017-10-18 |