| NPI | 1255106084 |
|---|---|
| Doing Business As | MAIN STREET DENTAL |
| Entity Type | Organization |
| Authorized Contact | MARK CHRISTENSEN Credentialing Specialist 801-691-1701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2023-11-21 |