| NPI | 1902325749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RHONDA MARIE ELQUIST Regional Operations Manager 208-580-7091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID d-4186-pd) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2017-09-13 |