| NPI | 1922480144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF SCOTT BURG Dentist Owner 801-618-0246 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5096414) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2016-08-18 |