| NPI | 1508196189 |
|---|---|
| Former Legal Business Name | BASIC DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CHARLES SCOTT GRACE Dds/ Owner 208-342-7714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3522) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2010-01-05 |