| NPI | 1255766820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | M ANDREW JOHNSON Manager 435-753-2153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 141633 9921) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2013-09-13 |