| NPI | 1093083990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LEWIS Specialist Coordinator 801-782-5682 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 144024-9922) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2011-12-06 |