| NPI | 1023143088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY J. OLSEN Doctor Of Dental Surgery 435-628-5496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 309573-9923) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-08-22 |