| NPI | 1841201548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STAN RASMUSSEN Vice President 208-765-3322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D1899) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D1528) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |