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Salt Lake City, Utah

Provider NPI: 1558487827

Organization Information:
Organization is not Subpart
Authorized Official:  JEREMY DWIGHT MANWARING  OWNER  801-2938833

Practice Location:
Tel: 801-293-8833  Fax: 801-293-8844

Business Mailing Address:
Tel: 801-293-8833  Fax: 801-293-8844

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223P0300XDental Providers


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