| NPI | 1972863207 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNDA DEL RIO Office Manager 208-747-2651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WY 1191) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |