| NPI | 1639567043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAREN LYNN LARSEN Owner 435-781-2729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 3411869922) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: UT 65632849922) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |