| NPI | 1972779916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE SCHMIDT Receptionist 208-523-2160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID d3728) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2008-04-30 |