| NPI | 1891833547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BART T WATTS Owner 801-572-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 1440869922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 1442799922) |
| 1223G0001X Dentist, General Practice | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2008-07-15 |