| NPI | 1497164032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RILEY DEAN CLARK Dentist 435-657-1205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: UT 9053425-8903) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2014-08-07 |