| NPI | 1124477146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALY HANCOCK Office Manager 801-334-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8290111-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8698145-9922) |
| 1223G0001X Dentist, General Practice (Licence: UT 6267384-9922) | |
| 124Q00000X Dental Hygienist (Licence: UT 9032036-9920) | |
| 124Q00000X Dental Hygienist (Licence: UT 119249-9920) | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |