| NPI | 1437684099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN RODNEY HILLAM Orthodontist 208-524-1800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID 4648) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2017-04-20 |