| NPI | 1053648881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERALD W GEDDES Authorized Representative 801-394-5554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 144437) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2009-11-20 |