| NPI | 1740457332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G. SUMMERS Owner 208-232-0464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3284-OR) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |