| NPI | 1568902286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY ROGERS Pediatric Dentist 208-376-8873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D3725-PD) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |