| NPI | 1730752908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN AGNETTA Office Manager 208-863-6861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |