| NPI | 1588786875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY CHRISTENSE Partner 208-527-3472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3703) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2008-03-25 |