| NPI | 1457874059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN HANSEN President 435-760-4346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 8362186-9922) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2017-07-25 |