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114 E 12450 S Suite 200 Draper UT 84020 | |
| (801) 495-1610 | |
| (801) 495-1631 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 114 E 12450 S, Draper, Utah |
| Authorized Official Name and Position | Annie C Huffman (BILLING MANAGER) |
| Authorized Official Contact | 8014951610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 830 Draper UT 84020 Ph: (801) 495-1610 | 114 E 12450 S Suite 200 Draper UT 84020 Ph: (801) 495-1610 |
| NPI Number | 1790793776 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790793776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 342300 (Utah) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | 5832460 (Utah) | Primary |
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