| NPI | 1205337391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES E RUSSON Owner 801-294-5781 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 138216-9922) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2018-05-16 |