| NPI | 1285750554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LELAND WILLIAM PACK President 801-621-5892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 324142-9921) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-09-13 |