| NPI | 1982123923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEOFFREY GRANT President 801-597-4570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: UT 9540983-9922) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2017-09-11 |