| NPI | 1124102595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALYSHIA RICE Provider Relations 801-453-9625 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| 1223P0221X Dentist, Pediatric Dentistry | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-09-08 |