| NPI | 1780037705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS GARTH STODDARD Owner 208-453-6188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D4186PD) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D4031) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2016-07-14 |