| NPI | 1902007354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY K. CLARK President 801-572-1130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 141551-9922) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2020-08-22 |