| NPI | 1679704647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP HARPER Owner/Dentist 208-524-2300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: ID D4056) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: ID D4164) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2019-03-13 |