| NPI | 1801274253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA ELQUIST Office Manager 208-453-6188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2015-06-08 |