| NPI | 1023882271 |
|---|---|
| Other Name | BLUE MOUNTAIN DENTAL |
| Entity Type | Organization |
| Authorized Contact | JESSE BLOOMFIELD Doctor 435-406-4006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-08 |