| NPI | 1912766882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON SCOTT BULLOCH Doctor 435-652-1445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-04-30 |