| NPI | 1760251664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON D LAWSON Dentist 435-840-1040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2023-12-22 |