| NPI | 1821866682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER LEAVITT Owner/Dentist 208-240-5219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2023-12-12 |