| NPI | 1801112628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSETTE BRIZZEE Office Manager 208-354-8181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-1657) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: ID D3634) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2010-04-19 |