| NPI | 1245607068 |
|---|---|
| Former Legal Business Name | MAIN STREET DENTAL OF SALT LAKE CITY |
| Entity Type | Organization |
| Authorized Contact | JENNIFER D WILSON Manager/Owner 801-792-6033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-08-27 |