| Southridge Dentistry | |
|
3723 W 12600 S Ste 430 Riverton UT 84065-7310 | |
| (801) 285-4200 | |
| Not Available |
| Full Name | Southridge Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3723 W 12600 S Ste 430, Riverton, Utah |
| Authorized Official Name and Position | Seth Glickman (INTMN MEDICAL GROUP PRES/CMO CBC) |
| Authorized Official Contact | 8014422905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southridge Dentistry Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 285-4200 | Southridge Dentistry 3723 W 12600 S Ste 430 Riverton UT 84065-7310 Ph: (801) 285-4200 |
| NPI Number | 1073177648 |
|---|---|
| Provider Enumeration Date | 04/29/2019 |
| Last Update Date | 04/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073177648 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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