| NPI | 1588823264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS N HUGUES Officer 208-238-1165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D3679) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2014-08-20 |