| NPI | 1902688492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT D HACK Owner 801-636-0110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Additional Taxonomies | 124Q00000X Dental Hygienist |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |