| NPI | 1700447596 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAILEY ANNE HOUSLEY Pediatric Dentist, Owner 208-419-3622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-06-24 |