| NPI | 1548668353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT FERGUSON Co Owner 801-475-5577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 272251-9922) |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2014-12-10 |