| NPI | 1821382342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN A NEIBAUR Owner 801-269-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 4990210-9921) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2011-06-01 |