| NPI | 1447048376 |
|---|---|
| Doing Business As | CENTENNIAL DENTAL |
| Entity Type | Organization |
| Authorized Contact | JON MICHAEL KOELTL Owner/Dentist 208-322-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-04-29 |