| NPI | 1487150827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD G. WILKINS Registered Agent/Member 801-263-2633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 140211-9922) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-04-04 |