| NPI | 1285044206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MATTHEW PRINCE Owner 435-654-2822 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 5923720) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8006231-9922) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2014-04-29 |