| NPI | 1487046363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERONICA MONTGOMERY President 208-939-7620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D-4631) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |