| NPI | 1851554737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY JERALD MOON President 208-939-7053 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D3387) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2008-07-09 |