| NPI | 1841395589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN ELLIOTT Owner 208-773-4579 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-02-07 |