| NPI | 1073735619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN T RANDLE Owner 801-474-9552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 346388-9921) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |