| NPI | 1568095883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLE W ANDERSON Member 208-343-0909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2020-02-14 |