| NPI | 1326584921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS WHITE President 435-828-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 101772830160) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-01-06 |