| NPI | 1881835353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WEBSTER Office Manager 208-855-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3724) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |