| NPI | 1528092913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN K HENDRICKSON Dentist 435-656-0507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 3043) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-08-22 |