| NPI | 1003102807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN ERIC CHANDLER Owner 801-571-3446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5386766) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2011-06-21 |