| NPI | 1083921704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT PACKHAM Managing Member 801-779-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: UT 6362621-9922) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2010-09-01 |