| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 225 S. Main, Monticello, Utah |
| Authorized Official Name and Position | Tamra Lewis (OFFICE MANAGER) |
| Authorized Official Contact | 4355872700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1125 Monticello UT 84535-1125 Ph: (435) 587-2700 | 225 S. Main Monticello UT 84535 Ph: (435) 587-2700 |
| NPI Number | 1346648094 |
|---|---|
| Provider Enumeration Date | 12/11/2014 |
| Last Update Date | 12/11/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346648094 | NPI | - | NPPES |
| 1376698324 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 6216233-9922 (Utah) | Primary |
San Juan Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 217 S. 100 W., Monticello, UT 84535 Phone: 435-587-2528 Fax: 435-587-3585 |