MEDICARE: GREAT SMILES DENTAL CLINIC 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
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	135181	UT
2	1223G0001X	General Practice Dentistry	9030705	UT

General Provider Information

NPI Number	:	1447623830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT SMILES DENTAL CLINIC LLC

Provider Business Mailing Address
First Line	:	333 E MAIN ST
Second Line	:	#351
City	:	LEHI
State	:	UT
Zip	:	84043-4200
Country	:	US
Telephone Number	:	801-642-4080
Fax Number	:

Provider Business Practice Location Address
First Line	:	7410 S CREEK RD
Second Line	:	#303
City	:	SANDY
State	:	UT
Zip	:	84093-6140
Country	:	US
Telephone Number	:	801-642-4080
Fax Number	:

Authorized Official
Title or Position	:	GMP
Name	:	MR. JOSHUA RODRIGGS
Credential	:
Telephone Number	:	385-355-1434

Provider Enumeration Date	:	11/06/2015
Last Update Date	:	11/06/2015

Similar Medicare Providers

1811964521 — JONATHAN M RASMUSSEN DDS
Practice Location Address:

7410 CREEK RD
SANDY, UT
84093-6140

Practice Phone: 801-352-7889
Practice Fax:

1912274051 — CREEK ROAD ORTHODONTICS AND PEDIATRIC DENTISTRY
Practice Location Address:

7410 CREEK RD , SUITE #200
SANDY, UT
84093-6140

Practice Phone: 801-562-5505
Practice Fax:

1295351278 — HEALTHY MIND SET INTL INC
Practice Location Address:

7410 S CREEK RD STE D100
SANDY, UT
84093-6140

Practice Phone: 801-816-1010
Practice Fax:

1881696904 — DR. BRIAN LEE HOMER D.M.D.
Practice Location Address:

7369 CREEK RD
SANDY, UT
84093-6154

Practice Phone: 801-566-5577
Practice Fax: 801-566-4848

1710988548 — DR. RODNEY C DAVIS DC
Practice Location Address:

2061 E 9400 S
SANDY, UT
84093-3128

Practice Phone: 801-733-0550
Practice Fax: 801-733-0075

1396737490 — MARK CHRISTIAN ROBISON MD
Practice Location Address:

1982 E VISCOUNTI CV
SANDY, UT
84093-1059

Practice Phone: 612-990-6018
Practice Fax:

Directions to “GREAT SMILES DENTAL CLINIC LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.