Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 785 E 200 S, Lehl, Utah |
Authorized Official Name and Position | Jacob Warner (CREDENTIALING MANAGER) |
Authorized Official Contact | 8016911701 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 970483 Orem UT 84097 Ph: (801) 691-1701 | 785 E 200 S Ste 1 Lehl UT 84043 Ph: (801) 331-8545 |
NPI Number | 1851722383 |
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Provider Enumeration Date | 12/10/2013 |
Last Update Date | 07/06/2021 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851722383 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 3104344 (Utah) | Primary |