| NPI | 1710164793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL ROYAL SKOUSEN President 208-375-3755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D4019) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2008-01-22 |