| NPI | 1962568782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAT M MILTON Office Manager 208-466-8400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3610) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2015-04-21 |