| NPI | 1467916528 |
|---|---|
| Other Name | WISDOM TEETH OF SOUTHERN UTAH |
| Entity Type | Organization |
| Authorized Contact | DAYNE JENSEN Owner 435-673-3490 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |