| NPI | 1134523459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD K JOLLEY Co Owner 435-789-2888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 137338) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2014-10-15 |