| NPI | 1760762868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RYAN DAVIS Owner/ Dentist 208-440-7384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4373) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2018-03-07 |