| NPI | 1154047918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY BRANDON KEHL Mangaing Member 801-833-0474 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2022-10-13 |