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6822 E 1000 South Fort Duchesne UT 84026 | |
(435) 722-5122 | |
Not Available |
Full Name | |
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Speciality | Dentist |
Location | 6822 E 1000 South, Fort Duchesne, Utah |
Authorized Official Name and Position | Delbert Gary Martin (CHIEF PHARMACIST) |
Authorized Official Contact | 4357256874 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6822 E. 1000 South Fort Duchesne UT 84026 Ph: (435) 722-5122 | 6822 E 1000 South Fort Duchesne UT 84026 Ph: (435) 722-5122 |
NPI Number | 1730341215 |
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Provider Enumeration Date | 06/26/2008 |
Last Update Date | 04/04/2013 |
Identifier | Type | State | Issuer |
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1730341215 | NPI | - | NPPES |
AZ0522260 | Other | AZ | BLUE CROSS BLUE SHIELD |
700000000009 | Medicaid | UT |