| NPI | 1477723955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE J MALLORY Office Manager 208-436-4532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID d3903) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |