| NPI | 1780694885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS MARK VAN DEN BERGHE Owner 801-233-0503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 55467) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-08-22 |