| NPI | 1548637994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS DANCE Owner 208-772-2202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-4050-PD) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: ID D-4050-PD) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2018-08-14 |