| NPI | 1558744748 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN AUSTIN Owner 801-399-3701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: UT 9105773) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |