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1548 E 4500 S #104 Holladay UT 84117 | |
| (801) 272-8051 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 1548 E 4500 S #104, Holladay, Utah |
| Authorized Official Name and Position | Tracie Sullivan (ACCOUNTS RECEIVABLE, DIRECTOR) |
| Authorized Official Contact | 8018491045 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1548 E 4500 S #104 Holladay UT 84117 Ph: (801) 272-8051 | 1548 E 4500 S #104 Holladay UT 84117 Ph: (801) 272-8051 |
| NPI Number | 1063052256 |
|---|---|
| Provider Enumeration Date | 01/15/2020 |
| Last Update Date | 06/29/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063052256 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | (* (Not Available)) | Primary |
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