| NPI | 1891960688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT D. MCWHORTER Owner/President 208-237-1567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D-3451-PD) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2013-02-01 |