| NPI | 1396211082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATHUE FAULKNER Owner 801-808-4756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2018-10-19 |