| NPI | 1457133779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT D HACK Owner 801-636-0110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Additional Taxonomies | 122300000X Dentist |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2023-10-20 |
| Last Update Date | 2024-02-07 |