| NPI | 1306291422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAELOR JEPPSON Insurance COO Rdinator 801-305-3460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2016-04-26 |