| NPI | 1891871521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RUSSELL BURT President 208-785-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D1995) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2020-08-22 |