NPI | 1740166099 |
---|---|
Entity Type | Organization |
Authorized Contact | MARK CHRISTENSEN Credentialing Specialist 801-305-3460 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice |
Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology |
1223P0300X Dentist, Periodontics | |
Enumeration Date | 2025-08-13 |
Last Update Date | 2025-08-13 |