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 |