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 |