| NPI | 1538596424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAL ALETA SWENSON Clinical Manager 208-552-5520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D1303) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2013-10-09 |