| NPI | 1457704009 |
|---|---|
| Doing Business As | FAIRVIEW DENTAL |
| Entity Type | Organization |
| Authorized Contact | KEITH L STUCKI Manager 208-459-3388 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3315) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-07-19 |