| NPI | 1851005904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM FREI Owner/Partner 208-821-2206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2026-01-09 |