| NPI | 1669661427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM KELLER Owner 208-466-2456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID d3065) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2022-03-10 |