| NPI | 1972764058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ANDERSON Vice President 208-884-4466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4145) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2008-08-06 |