| NPI | 1477712966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY J TREBILCOCK Dentist 208-782-0242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3133) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |