| NPI | 1184132623 |
|---|---|
| Doing Business As | ACADEMY SQUARE DENTAL CARE |
| Entity Type | Organization |
| Authorized Contact | CORBIN MATTHEWS Owner 801-473-6455 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 125K00000X Advanced Practice Dental Therapist (Licence: UT 372923) |
| Additional Taxonomies | 125K00000X Advanced Practice Dental Therapist (Licence: UT 8372408-9922) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-01-18 |