| NPI | 1518298421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY SHANE BARLOW Dentist 208-777-9331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID 09-0863) |
| Enumeration Date | 2010-01-18 |
| Last Update Date | 2010-01-18 |