| NPI | 1457378382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEAN CHARLES YOUNCE President 208-939-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-3178-OS) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2007-09-05 |