| NPI | 1942471966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREN E SHORT President 208-454-4112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: ID D-4121-OR) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |