| 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 |