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NPI Code Detail

MEDICARE: ACCESSIBLE DENTAL LLC

MEDICARE: ACCESSIBLE DENTAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11902034119OTHERNPI
21699902106OTHERNPI
31225327281OTHERNPI

General Provider Information

NPI Number : 1407490402
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACCESSIBLE DENTAL LLC
Provider Business Mailing Address
First Line : 1236 E CEDAR RIDGE RD
Second Line :
City : SANDY
State : UT
Zip : 84094-5603
Country : US
Telephone Number : 801-572-5552
Fax Number :
Provider Business Practice Location Address
First Line : 1236 E CEDAR RIDGE RD
Second Line :
City : SANDY
State : UT
Zip : 84094-5603
Country : US
Telephone Number : 801-572-5552
Fax Number :
Authorized Official
Title or Position : CO-OWNER
Name : CORTNEY HUMPHREY
Credential : RDH
Telephone Number : 801-916-0200
Provider Enumeration Date : 11/01/2019
Last Update Date : 11/01/2019

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Directions to “ACCESSIBLE DENTAL LLC ” Practice Location

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