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1030 E 11400 S Ste 2a Sandy UT 84094-6906 | |
| (801) 406-8670 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1030 E 11400 S Ste 2a, Sandy, Utah |
| Authorized Official Name and Position | John Joshua Smith (MANAGING MEMBER) |
| Authorized Official Contact | 8016948378 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5406 W 11000 N Ste 103-226 Highland UT 84003-8942 Ph: (801) 899-5512 | 1030 E 11400 S Ste 2a Sandy UT 84094-6906 Ph: (801) 406-8670 |
| NPI Number | 1568974434 |
|---|---|
| Provider Enumeration Date | 10/31/2017 |
| Last Update Date | 10/31/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568974434 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7359070 (Utah) | Primary |
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Lone Peak Pediatric Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1030 E 11400 S, Suite #101, Sandy, UT 84094 Phone: 801-553-8882 | |
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