| NPI | 1598881906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY B THOMPSON Manager 435-283-4081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5684051-9922) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-08-22 |