| NPI | 1306338066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN N. BULLEN Orthodontist 801-787-6883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D3927) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: AZ D3927) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-05-30 |