| NPI | 1295153831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DRAKE G. VINCENT Managing Member 801-716-7006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 4737943) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |