| NPI | 1396893012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER JOHNSON Office Manager 801-426-6255 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6026130) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 3192) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-01-04 |