| NPI | 1962629527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN M ELLIOTT Partner 208-382-3558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D3280) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH D3826) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |