| NPI | 1053743922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK NELSON Part Owner 801-295-8322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 2013-45880) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2013-08-02 |