| NPI | 1104036763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH OSTHELLER Owner 801-770-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 2787109922) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-01-22 |