| NPI | 1164920096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN D JACKSON Dentist 801-489-6811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: UT 7025515) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-01-25 |