| NPI | 1144338575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN RUSSELL Dentist 435-940-9900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 57294409922) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2020-08-22 |