| NPI | 1235505587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK LYMAN NELSON Dentist/Owner 801-295-8322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 141802) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2015-08-20 |