| Utah Dental Providers | |
|
1909 W 4700 S Salt Lake City UT 84118-1105 | |
| (801) 968-9548 | |
| Not Available |
| Full Name | Utah Dental Providers |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1909 W 4700 S, Salt Lake City, Utah |
| Authorized Official Name and Position | John Everett Ballard (CIO) |
| Authorized Official Contact | 9727550800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utah Dental Providers 4100 Mcewen Rd Suite 110 Dallas TX 75244-5113 Ph: (972) 755-0800 | Utah Dental Providers 1909 W 4700 S Salt Lake City UT 84118-1105 Ph: (801) 968-9548 |
| NPI Number | 1104903152 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104903152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 18458 (Texas) | Primary |
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