| NPI | 1548434459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W HAWN President 208-265-4558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2023-09-05 |