| NPI | 1548792468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE HOROWITZ Insurance Manager 801-566-5117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2021-03-23 |