Southridge Pediatric Dentistry | |
2651 W. 10400 S. #103 South Jordan UT 84095 | |
(801) 445-1515 | |
(801) 446-5290 |
Full Name | Southridge Pediatric Dentistry |
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Speciality | Dentist |
Location | 2651 W. 10400 S. #103, South Jordan, Utah |
Authorized Official Name and Position | David C Roth (OWNER) |
Authorized Official Contact | 8014461515 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Southridge Pediatric Dentistry 2651 W. 10400 S. #103 South Jordan UT 84095 Ph: (801) 445-1515 | Southridge Pediatric Dentistry 2651 W. 10400 S. #103 South Jordan UT 84095 Ph: (801) 445-1515 |
NPI Number | 1225249683 |
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Provider Enumeration Date | 05/25/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
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1225249683 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 343291 (Utah) | Primary |
122300000X | Dentist | 5667938 (Utah) | Secondary |
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