| NPI | 1801241922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SPENCER WIRIG Owner 208-664-0884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D4020) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: ID D4020) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2016-04-26 |