| NPI | 1881069177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LEWIS Specialist Coordinator 801-782-5682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 8041458) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: UT 145326-9922) |
| 1223E0200X Dentist, Endodontics (Licence: UT 145288-9922) | |
| 1223P0300X Dentist, Periodontics (Licence: UT 137712-9922) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 8598613-9924) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 9371431-9921) | |
| Enumeration Date | 2015-12-11 |
| Last Update Date | 2015-12-11 |