| NPI | 1679743470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE WAYNE MEADORS Owner/Member 208-938-6343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D3120PD) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-03-07 |