NPI: 1497803696 · IDAHO FALLS, ID 83404 · Dentist · NPI assigned 01/07/2007
| Authorized Official | LARSEN, TRACY (OFFICE MANAGER) |
| NPI Enumeration Date | 01/07/2007 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 12 | $0.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1208 | Topical application of fluoride, excluding varnish | 12 | 12 | $0.00 |