| Blue Mountain Family Dental | |
|
1675 N 200 W #8a Provo UT 84604 | |
| (801) 356-7329 | |
| Not Available |
| Full Name | Blue Mountain Family Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1675 N 200 W #8a, Provo, Utah |
| Authorized Official Name and Position | Justin Todd Hilmo (GENERAL DENTIST) |
| Authorized Official Contact | 8013567329 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Mountain Family Dental 1675 N 200 W #8a Provo UT 84604 Ph: (801) 356-7329 | Blue Mountain Family Dental 1675 N 200 W #8a Provo UT 84604 Ph: (801) 356-7329 |
| NPI Number | 1003206350 |
|---|---|
| Provider Enumeration Date | 01/26/2015 |
| Last Update Date | 01/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003206350 | NPI | - | NPPES |
| 050828 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 7369645 (Utah) | Primary |
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