| NPI | 1700241809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY BONANDER Dentist/Owner 208-559-6122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: AZ D8861) |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2015-12-16 |