| NPI | 1669771069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRODIE STEVEN ATWOOD President 208-313-0520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D4289) |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2011-03-24 |