| NPI | 1831338623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RYAN JOHANSEN Owner 801-519-2222 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 49534949923) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-02-18 |