| NPI | 1902118557 |
|---|---|
| Other Name | MAIN STREET DENTAL OF MAGNA |
| Entity Type | Organization |
| Authorized Contact | BRYAN ELDEN GOTTFREDSON Dentist/ Owner 801-250-7311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 360010-9922) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2010-07-12 |