| NPI | 1629449269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN BAUTER Owner 208-344-8363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4357) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-08 |