| NPI | 1538186366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN J. PRUETT Office Manager 208-785-2685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3613) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2020-08-22 |