| NPI | 1568944502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM BENSON KELLER Owner/Dentist 208-466-2456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D3065) |
| Enumeration Date | 2018-09-06 |
| Last Update Date | 2018-09-06 |