| NPI | 1811329956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC ADAM COLLMAN Owner 801-782-9544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 931439079922) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2013-07-31 |