| NPI | 1992716104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA KIM FLORES Admistative Assistant 208-895-6611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 142755-9922) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-06-19 |