| NPI | 1457608671 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRUDEE L CHAPPLE Office Administrator 208-523-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1890) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-3271) |
| 122300000X Dentist (Licence: ID D4224) | |
| 1223G0001X Dentist, General Practice (Licence: ID D3063) | |
| 1223G0001X Dentist, General Practice (Licence: ID d4138) | |
| 1223G0001X Dentist, General Practice (Licence: ID D1608) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2014-03-14 |