| Main Street Dental Of Magna | |
|
9010 W 2700 S Magna UT 84044-1002 | |
| (801) 250-7311 | |
| (801) 250-3801 |
| Full Name | Main Street Dental Of Magna |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9010 W 2700 S, Magna, Utah |
| Authorized Official Name and Position | Bryan Elden Gottfredson (DENTIST/ OWNER) |
| Authorized Official Contact | 8012507311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Dental Of Magna 9010 W 2700 S Magna UT 84044-1002 Ph: (801) 250-7311 | Main Street Dental Of Magna 9010 W 2700 S Magna UT 84044-1002 Ph: (801) 250-7311 |
| NPI Number | 1902118557 |
|---|---|
| Provider Enumeration Date | 07/12/2010 |
| Last Update Date | 07/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902118557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 360010-9922 (Utah) | Primary |
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