| NPI | 1740888023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVAN JAMES AGNETTA Owner/Manager 208-761-1210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |