| NPI | 1649453275 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDE STUART Office Administrator 208-232-2807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID d3016) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2010-06-16 |