| NPI | 1497083638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WALLACE MORRISN Owner 208-882-0331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3321-OS) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2009-11-30 |