| NPI | 1174240105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY PAVICK Sr. Operations Manager 801-857-7947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |