| NPI | 1891921052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM BENSON KELLER Owner 208-466-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3065) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |