| NPI | 1558487827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY DWIGHT MANWARING Owner 801-293-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 56827969922) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-07-23 |