| NPI | 1972740249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID R STEVENS Manager 435-673-3363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 5929127-9923) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |