| NPI | 1972968998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN A BEAUDRY Owner 208-344-0908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: ID D-4444-PE) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2015-12-17 |