| NPI | 1952436883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES GORDON SIMPSON V President Dentist 208-785-0310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID d1394) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |