| NPI | 1770725772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REANA LYN Office Manager 208-359-5454 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1303) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2009-04-06 |