| NPI | 1790229003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRELL F TINGEY Owner 208-375-0631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID d-1731) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2016-12-06 |