| NPI | 1871753608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA FRAME Practice Administrator 208-733-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3892) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 122300000X Dentist (Licence: ID D4455) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2014-02-06 |