| NPI | 1962917658 |
|---|---|
| Doing Business As | GOODYEAR FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | KALLEN CLINTON WHEELER Dentist 208-757-8784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 31987) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2020-05-13 |