| NPI | 1578638854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN DANIEL STEVENSON Owner, President 801-302-7938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5863508-9923) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-11-18 |