| NPI | 1730675976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON H MORGAN Owner CEO 208-229-0403 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: CA DDS50648) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2018-07-10 |