| NPI | 1912212895 |
|---|---|
| Doing Business As | WISDOM TEETH ONLY |
| Entity Type | Organization |
| Authorized Contact | HEATH HENDRICKSON Owner 801-370-0050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 51365979922) |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2010-08-16 |