| 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 |