| NPI | 1831101518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREL L MOONEY Owner 208-336-9333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223P0300X Dentist Periodontics |
| 1223P0700X Dentist Prosthodontics | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2020-08-22 |