| NPI | 1689976318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY B. ELISON Manager 801-768-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2010-12-01 |