| NPI | 1255776431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WOLPERT Director 801-627-0420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 8289908) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-01 |