| NPI | 1629295274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN M ELLIOTT Partner 208-634-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3826) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D3280) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |