| NPI | 1255857728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIELS HENDRICKSON Manager 435-215-6621 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 143297) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2022-07-21 |