| NPI | 1770770026 |
|---|---|
| Former Legal Business Name | EMERALD DENTAL ASSOCIATES PC |
| Entity Type | Organization |
| Authorized Contact | JILL SHELTON WAGERS Dentist 208-327-0337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2021-06-02 |