| NPI | 1639310089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EUGENE PETERSON President 208-853-4687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4142) |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2009-03-16 |