| NPI | 1386021848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE SULLIVAN Director Of Finance 801-566-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 144997) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2015-05-04 |