| NPI | 1760661482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYNE BLAZEK Office Manager 208-228-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1992) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3281) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |