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Post Falls, Idaho

Provider NPI: 1295035020

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 208-262-2620  Fax: --

Business Mailing Address:
Tel: 208-262-2620  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N1223E0200XDental Providers
WADE 60171338
Y1223E0200XDental Providers


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