| NPI | 1508387564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK SPENCER MCGOWAN Owner 801-203-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 8008797) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |