| NPI | 1720259484 |
|---|---|
| Doing Business As | PEDIATRIC DENTAL CENTER OF NORTH IDAHO |
| Entity Type | Organization |
| Authorized Contact | JOHN M UKICH President 208-667-3556 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D1656) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2008-03-20 |