| NPI | 1942508361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT T ALLEN Owner 208-529-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID D4152) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: ID D1641) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2011-03-09 |