| NPI | 1073177648 |
|---|---|
| Doing Business As | SOUTHRIDGE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | SETH GLICKMAN Intmn Medical Group Pres/Cmo Cbc 801-442-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-04-29 |