| NPI | 1942757570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JOHN Practice Admin 801-224-0222 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 4766943) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2017-03-23 |