| NPI | 1992179964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT PACKHAM Member 801-217-3359 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 6362621-9922) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2015-11-13 |