| NPI | 1063292738 |
|---|---|
| Former Legal Business Name | PRAIRIE VISTA DENTAL, LLC |
| Entity Type | Organization |
| Authorized Contact | BRADYN BISHOP Dentist 801-879-8381 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |