| NPI | 1629237540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MICHAEL KOWALCZYK Owner/Manager 208-342-5444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3689) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |