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1230 S Redwood Rd Salt Lake City UT 84104-3707 | |
| (775) 777-5888 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1230 S Redwood Rd, Salt Lake City, Utah |
| Authorized Official Name and Position | Benjamin Bowman (OWNER/PARTNER) |
| Authorized Official Contact | 4053268004 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1230 S Redwood Rd Salt Lake City UT 84104-3707 Ph: (385) 295-1601 | 1230 S Redwood Rd Salt Lake City UT 84104-3707 Ph: (775) 777-5888 |
| NPI Number | 1871162552 |
|---|---|
| Provider Enumeration Date | 06/17/2021 |
| Last Update Date | 06/17/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871162552 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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