| NPI | 1922269331 |
|---|---|
| Other Name | GRAND TETON DENTEAL CARE |
| Entity Type | Organization |
| Authorized Contact | JEFFREY WILDAN BOWMAN Owner Dentist 208-787-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D3162) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2008-06-18 |