| NPI | 1972782621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF ERICKSON Doctor Owner 435-673-9661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 61864309921) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: UT 1304029921) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |