| NPI | 1548429434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW A FOWLER President 208-468-9699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: ID D3264EN) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |