| NPI | 1801804893 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD JULES DUFOUR President CEO 208-674-4031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 20727) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 16627) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |