| NPI | 1427364801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATH J BLAKE President 801-785-8308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: UT 59590689921) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |