| NPI | 1992316251 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | KENYON L OYLER Owner/Provider 208-412-1773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2020-08-11 |