| NPI | 1649620139 |
|---|---|
| Doing Business As | PREMIER DENTISTRY OF EAGLE |
| Entity Type | Organization |
| Authorized Contact | SHANE STEVEN PORTER Dentist/Owner 208-938-1247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-4002) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |