| NPI | 1942317664 |
|---|---|
| Other Name | KOOTENAI FAMILY DENTAL, PA |
| Entity Type | Organization |
| Authorized Contact | ROBERT L WILDER Dentist 208-664-8283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID 3794) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2008-10-06 |