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12427 South 4000 West Suite #200 Riverton UT 84095 | |
| (801) 254-8812 | |
| (801) 254-4650 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 12427 South 4000 West, Riverton, Utah |
| Authorized Official Name and Position | John Peterson (OWNER/OPERATOR) |
| Authorized Official Contact | 8012548812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12427 South 4000 West Suite #200 Riverton UT 84095 Ph: (801) 254-8812 | 12427 South 4000 West Suite #200 Riverton UT 84095 Ph: (801) 254-8812 |
| NPI Number | 1821516063 |
|---|---|
| Provider Enumeration Date | 09/08/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821516063 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 7020843 (Utah) | Primary |
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