| NPI | 1972383941 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PYSNAK Owner 208-467-5100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |