| NPI | 1922404987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK MICHAEL DAVIDSON Owner 208-667-5447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4322) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2014-11-18 |