| NPI | 1992363444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB WARNER Credentialing Manager 801-691-1701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223E0200X Dentist Endodontics |
| 1223P0300X Dentist Periodontics | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-05-30 |