| NPI | 1528518909 |
|---|---|
| Other Name | DR. WISDOM TEETH |
| Entity Type | Organization |
| Authorized Contact | ELIZABETH GARCIA Office Manager 801-370-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 5136597) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 134055) |
| 364S00000X Clinical Nurse Specialist (Licence: UT 187982) | |
| 364S00000X Clinical Nurse Specialist (Licence: UT 5594772) | |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |