| NPI | 1801316641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC HALL Practice Administrator 435-201-6940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5500786-9922) |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2017-06-22 |