| NPI | 1316962079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J STALEY President/Owner 801-280-1911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 373483-9922) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-08-22 |