| NPI | 1972765865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE DAVID POPPLETON Owner 208-733-0695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-3554) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2008-07-01 |