| NPI | 1881869055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT WILLIAM GRANT Dentist 208-938-3190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3981) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2014-09-16 |