| NPI | 1861666745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT D. JACOBSON Owner/Dentist 208-524-0870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3203) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2020-08-07 |