| NPI | 1902916018 |
|---|---|
| Other Name | NORTH END DENTAL, PLLC |
| Entity Type | Organization |
| Authorized Contact | DOROTHY ANN MATTEFS Off Mgr 208-344-0134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D-1933) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D1933) |
| 1223G0001X Dentist General Practice (Licence: ID D4007) | |
| 1223G0001X Dentist General Practice (Licence: ID D-3957) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-12-11 |