| NPI | 1235449919 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG JACKSON ALLAN Dentist/President 801-565-7455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 5149430) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |