| NPI | 1891931028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE C. KELSON Secretary 208-375-3397 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: ID 01561) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |