| NPI | 1710184783 |
|---|---|
| Doing Business As | CANYON COUNTY ORAL MAXILLOFACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | NICHOLAS A MASSOTH Oral Surgeon 208-459-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: ID D3848OS) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2007-07-10 |