| NPI | 1649696741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C PAVENTY Owner/Dentist 208-342-0315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4286) |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2014-03-13 |