| NPI | 1700039351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINTON T BLACKWOOD Owner 801-274-2351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5936346) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |