NPI | 1790089886 |
---|---|
Entity Type | Organization |
Authorized Contact | L. DOUGLAS ISRAELSEN Owner 801-397-2727 |
Organization Subpart ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 135181) |
Enumeration Date | 2011-01-04 |
Last Update Date | 2011-11-22 |