| NPI | 1023040763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY WILLIAM EGBERT Owner 801-265-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 143512) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-08-22 |