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2779 W 4000 S Ste 101 Roy UT 84067-9603 | |
| (801) 731-5528 | |
| (801) 731-8369 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2779 W 4000 S, Roy, Utah |
| Authorized Official Name and Position | Michael Getz Crookston (CO-OWNER) |
| Authorized Official Contact | 8017315528 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2779 W 4000 S Ste 101 Roy UT 84067-9603 Ph: (801) 731-5528 | 2779 W 4000 S Ste 101 Roy UT 84067-9603 Ph: (801) 731-5528 |
| NPI Number | 1093062978 |
|---|---|
| Provider Enumeration Date | 08/09/2012 |
| Last Update Date | 08/30/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093062978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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