| NPI | 1073928305 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KASE PEERY Business Manager 801-969-9669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 7579613-9923) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: UT 5672733-9922) |
| 1223G0001X Dentist General Practice (Licence: UT 8919236-9921) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: UT 9474332-9922) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 135181-9924) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: UT 317724-8903) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2016-03-23 |