| NPI | 1760531214 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLAN WALKER STEVENSON President 208-722-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3204) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-08-22 |