| NPI | 1043725799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL MADSEN Managing Member 801-268-3636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 5639652) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: UT 77525365) |
| Enumeration Date | 2017-12-04 |
| Last Update Date | 2017-12-04 |