| NPI | 1770754186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN ALLEN SMITH Owner 208-323-4458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID D-3036-OR) |
| Enumeration Date | 2008-03-13 |
| Last Update Date | 2008-03-13 |