| NPI | 1568866119 |
|---|---|
| Other Name | EASY WISDOM TEETH |
| Entity Type | Organization |
| Authorized Contact | KEN JOHN MARZ Owner 801-886-3379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 275551-9922) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2014-10-10 |