| NPI | 1881049278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI L RADFORD Office Manager 208-745-1911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D4055) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID d4717) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2016-05-04 |