| NPI | 1689942849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY BRYSON Owner/Dentist 208-467-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D-4399-PD) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2021-11-08 |