| NPI | 1891122776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD B FISHER Owner 208-442-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D1705) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2013-10-09 |