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1955 S 1300 E Ste L2 Salt Lake City UT 84105-3675 | |
| (801) 486-9649 | |
| (801) 486-9640 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1955 S 1300 E Ste L2, Salt Lake City, Utah |
| Authorized Official Name and Position | Jared Theurer (DOCTOR) |
| Authorized Official Contact | 8014869649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1955 S 1300 E Ste L2 Salt Lake City UT 84105-3675 Ph: (801) 486-9649 | 1955 S 1300 E Ste L2 Salt Lake City UT 84105-3675 Ph: (801) 486-9649 |
| NPI Number | 1578928172 |
|---|---|
| Provider Enumeration Date | 12/23/2015 |
| Last Update Date | 04/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578928172 | NPI | - | NPPES |
| 1700897428 | Other | UT | NPI |
| 1023423258 | Other | UT | NPI |
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