| NPI | 1538577655 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RUPP Owner 801-463-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 6273877) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7348465) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2014-08-01 |