| NPI | 1457649675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY J CHRISTLEY Credentialling Coordinator 435-884-3476 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5125133-9921) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2023-07-31 |