| NPI | 1487696704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BECK BLACK President 801-278-0458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 137953) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-08-22 |