| NPI | 1215636501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY PETERSON Owner 801-471-8141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2023-08-29 |