| NPI | 1811146327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR SMITH Owner 208-734-7415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4351-PD) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2016-05-16 |