| NPI | 1841461761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMISON R SPENCER Provider/Owner 208-261-5687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO DEN9569) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2010-03-05 |