| NPI | 1992257372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD M GOERCKERITZ Owner 801-495-3567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7015094) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |