| NPI | 1750574810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS L BRADSHAW Periodontist 435-652-1605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: UT 275219) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |