| NPI | 1073010955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYKER WELLS Dentist 801-737-4650 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9418886) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-04-09 |