| NPI | 1720419369 |
|---|---|
| Doing Business As | MT BALDY DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | LYNN JENSEN Finacial Officer 208-263-6806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2013-12-09 |