| NPI | 1467820068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE MARIE-OSGOOD FUKUOKA Owner 208-859-8449 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID 4533) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |