| NPI | 1669480711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED BRION LOWRY Dentist 208-377-0410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1566) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |