| NPI | 1083978316 |
|---|---|
| Doing Business As | WISDOM TEETH ONLY |
| Entity Type | Organization |
| Authorized Contact | RAYMOND HEATH HENDRICKSON Owner 801-370-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5136599922) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2012-07-02 |