| NPI | 1649610726 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M HENINGER President/Part Owner 208-524-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1920) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2013-07-03 |