| NPI | 1679747588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY G. SMITH Owner 208-542-1333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D3257PD) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2024-04-08 |