| NPI | 1861926677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY BARLOW President 208-777-9331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D3781-PD) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2017-04-18 |