| NPI | 1881602266 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUANE KENT GODFREY Dentist 208-529-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D1637) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3983) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2010-12-17 |