| NPI | 1477831766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEN WOLFE Insurance Coordinator 801-621-1835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 137308) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 6242001) |
| 1223G0001X Dentist, General Practice (Licence: UT 8029496) | |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2011-08-03 |