| NPI | 1881853208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN R BLAISDELL President/Owner 208-377-9696 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D1697) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |