MEDICARE: PRECISION DENTAL CARE, INC.

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1669991451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION DENTAL CARE, INC.

Provider Business Mailing Address
First Line	:	3950 S 2300 E
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1830
Country	:	US
Telephone Number	:	801-278-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 S 2300 E
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84124-1830
Country	:	US
Telephone Number	:	801-278-4783
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD FISHER
Credential	:
Telephone Number	:	801-278-4783

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	07/21/2022

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Directions to “PRECISION DENTAL CARE, INC. ” Practice Location

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