| NPI | 1104347061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL TORNOW Owner 801-876-7669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5015649-8903) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2017-06-30 |