| NPI | 1467715508 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN VANBIBBER Owner 801-231-6682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60282727) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |