| Creek Road Orthodontics And Pediatric Dentistry | |
|
7410 Creek Rd Suite #200 Sandy UT 84093-6140 | |
| (801) 562-5505 | |
| Not Available |
| Full Name | Creek Road Orthodontics And Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7410 Creek Rd, Sandy, Utah |
| Authorized Official Name and Position | Barney Todd Olsen (DENTIST/OWNER) |
| Authorized Official Contact | 8015625505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Creek Road Orthodontics And Pediatric Dentistry 7410 Creek Rd Suite #200 Sandy UT 84093-6140 Ph: (801) 562-5505 | Creek Road Orthodontics And Pediatric Dentistry 7410 Creek Rd Suite #200 Sandy UT 84093-6140 Ph: (801) 562-5505 |
| NPI Number | 1912274051 |
|---|---|
| Provider Enumeration Date | 11/17/2011 |
| Last Update Date | 11/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912274051 | NPI | - | NPPES |
| 528962557001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 76505 (Utah) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 76505 (Utah) | Secondary |
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