| NPI | 1437682002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINT BLACKWOOD Dentist 801-938-8855 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 5936346) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |