| NPI | 1528742749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE PETERSON Office Manager 801-636-5792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2025-02-21 |