| NPI | 1902077001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK T. MCDONALD Dentist 208-467-9690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3958) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2016-06-09 |