| NPI | 1063960631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHET RAY COLEMAN Owner 801-966-9956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 144366) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: UT 144366) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-14 |