| NPI | 1639242084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL LEE VAN LEEUWEN President Dentist 801-943-1612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 1380749922) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2014-01-27 |