| NPI | 1770842593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE FADDIS President 801-785-8835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 145625) |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2015-12-11 |