| NPI | 1710147087 |
|---|---|
| Doing Business As | IDAHO PROSTHODONTICS |
| Entity Type | Organization |
| Authorized Contact | DARREL LAVERNE MOONEY Ownwe 208-841-5038 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: ID D1650PR) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |