| NPI | 1457896847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL BENJAMINE AUSTIN Member 801-550-4702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60377097) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60377097) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA GA60407769) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE60384474) | |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2016-12-21 |