| NPI | 1841654126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY GAYLE WILSON Office Manager 801-226-5315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: UT 137010) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2016-04-12 |