| NPI | 1780606616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA GORDON Director Of Insurance Coordination 208-882-3214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2023-03-07 |