| NPI | 1972762342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKS JOSEPH UNIAT Owner 208-938-0280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: ID D-3666) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2008-06-02 |