| 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 |