| NPI | 1003138843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY K RUPP Owner 801-635-4143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5352062) |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2018-04-12 |