| NPI | 1457593584 |
|---|---|
| Doing Business As | SOUTHRIDGE DENTAL |
| Entity Type | Organization |
| Authorized Contact | TODD LAWRENCE SQUIRES Owner 801-682-3097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-05-27 |