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6540 S State St Murray UT 84107-7219 | |
| (801) 590-8466 | |
| (801) 905-1934 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6540 S State St, Murray, Utah |
| Authorized Official Name and Position | Lorri Detrick (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9165636002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
8890 Cal Center Dr Sacramento CA 95826-3200 Ph: (916) 922-5000 | 6540 S State St Murray UT 84107-7219 Ph: (801) 590-8466 |
| NPI Number | 1225437353 |
|---|---|
| Provider Enumeration Date | 08/14/2014 |
| Last Update Date | 09/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225437353 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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