| NPI | 1851404032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J CARPER Office Manager 208-459-8505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3073) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-08-22 |