| NPI | 1619133923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT DOUGLAS FREEMAN Pediatric Dentist 208-377-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID 1479 PD) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |