| NPI | 1093018111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL MARK PORTER President 435-760-0189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 7828837) |
| Enumeration Date | 2010-12-11 |
| Last Update Date | 2010-12-11 |