Individual
NICHOLAS SANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 11TH AVE N, BUHL, ID 83316-1602
(208) 543-2747
Mailing address
124 11TH AVE N, BUHL, ID 83316-1602
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
101
ID
Other
Enumeration date
02/02/2016
Last updated
02/02/2016
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