| NPI | 1245618099 |
|---|---|
| Doing Business As | FORT UNION FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | TODD S LARSEN President 801-562-2147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 360817-9922) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2019-11-13 |