| NPI | 1689809980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN PATRICK WHITE Manager 208-288-1454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3972) |
| Enumeration Date | 2009-05-16 |
| Last Update Date | 2009-05-16 |