| NPI | 1285181131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADY THOMSON Owner/Orthodontist 435-752-1320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 4804772) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8041458) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2016-09-08 |