| NPI | 1669984902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYSON N GRAY Managing Partner 208-342-4644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 3799) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |