| NPI | 1568622876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY FANNIN Accounts Manager 208-342-0315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-1672) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |