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1383 S 900 W Suite 128 Salt Lake City UT 84104-1603 | |
| (801) 983-0350 | |
| (801) 983-0353 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1383 S 900 W, Salt Lake City, Utah |
| Authorized Official Name and Position | Stephanie M. Jensen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8019830351 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1383 S 900 W Suite 128 Salt Lake City UT 84104-1603 Ph: (801) 983-0350 | 1383 S 900 W Suite 128 Salt Lake City UT 84104-1603 Ph: (801) 983-0350 |
| NPI Number | 1851538862 |
|---|---|
| Provider Enumeration Date | 01/13/2009 |
| Last Update Date | 01/16/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851538862 | NPI | - | NPPES |
| 870422710002 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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