| NPI | 1679745269 |
|---|---|
| Doing Business As | BURTENSHAW CRAIG A & G STALEY GPS |
| Entity Type | Organization |
| Authorized Contact | GALEN JAY STALEY Partner 208-529-0120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3064) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D1628) |
| 122300000X Dentist (Licence: ID D3614) | |
| 122300000X Dentist (Licence: ID D3038) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-06-19 |