| NPI | 1588827125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD E. FERGUSON Owner 208-344-0908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: ID D-1669-PE) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |