| NPI | 1740636570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ROY MCDONOUGH Owner 801-266-2662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 6740566-9922) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |