| NPI | 1225249683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID C ROTH Owner 801-446-1515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 343291) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5667938) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |