| NPI | 1295130631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICAH G. MORTENSEN Owner 801-831-2662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WY 1344) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |