| NPI | 1821718669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WHITNEY N PAVICK Sr. Operations Manager 801-857-7947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2022-08-31 |