| NPI | 1154947372 |
|---|---|
| Doing Business As | IDENTITY ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | PRESTON HANSEN Owner 801-251-7167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |