| NPI | 1205111432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY L. SHAW Owner 801-731-4850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 132357) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2011-10-19 |