| NPI | 1255657722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE E FARLEY Member/Manager 801-225-0471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 56798149922) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |