| NPI | 1457546798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH DAVID BALLENGER Owner 208-467-1227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-2042-OS) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2008-02-26 |