| NPI | 1194331785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY ROBERTS Owner/Dentist 801-590-8694 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223P0700X Dentist, Prosthodontics | |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-09-18 |