| NPI | 1962644260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE LEE NEWTON Owner 208-315-2842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID d3280) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2009-04-01 |