| NPI | 1932368222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL AARON ELISON President 208-522-7216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3605) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2008-06-03 |