| NPI | 1992040299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOGAN F HAZARD President 208-215-1426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4401) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2012-11-28 |