| NPI | 1265984660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER SHINER President 435-828-4099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6712357-9923) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: UT 6712357-9923) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2020-11-18 |