| NPI | 1184991895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SHANE JESSEN Owner 801-479-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 52199299924) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2023-10-17 |