| NPI | 1720520505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER HANSEN Dentist/Partner 208-733-2621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4164) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2016-11-10 |