NPI | 1598115644 |
---|---|
Entity Type | Organization |
Authorized Contact | WARREN R WILLIS President 208-887-9000 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-4721) |
Enumeration Date | 2016-06-20 |
Last Update Date | 2016-06-20 |