| NPI | 1881908622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JACKSON Office Manager 801-571-8391 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 138455-9922) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |