NPI | 1528566494 |
---|---|
Entity Type | Organization |
Authorized Contact | JONATHAN D JACKSON Dentist 801-796-7779 |
Organization Subpart ? | No |
Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 7025515) |
Enumeration Date | 2018-01-25 |
Last Update Date | 2018-01-25 |