| NPI | 1699051250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK ELKINS President 208-369-4532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3922) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2012-03-28 |