| South Jordan Pdc Pllc | |
|
10458 S Redwood Rd South Jordan UT 84095-8501 | |
| (801) 302-8989 | |
| Not Available |
| Full Name | South Jordan Pdc Pllc |
|---|---|
| Speciality | Dentist |
| Location | 10458 S Redwood Rd, South Jordan, Utah |
| Authorized Official Name and Position | Juan Carlos Chavez (OWNER) |
| Authorized Official Contact | 8013028989 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Jordan Pdc Pllc Po Box 970113 Orem UT 84097-0309 Ph: (801) 305-3460 | South Jordan Pdc Pllc 10458 S Redwood Rd South Jordan UT 84095-8501 Ph: (801) 302-8989 |
| NPI Number | 1336706043 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 05/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336706043 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Secondary |
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