Healthcare Provider Details

I. General information

NPI: 1629982475
Provider Name (Legal Business Name): WEEKEND DENTAL MERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 N LESLIE WAY STE 100
MERIDIAN ID
83646-5362
US

IV. Provider business mailing address

6955 S UNION PARK CTR STE 510
COTTONWOOD HEIGHTS UT
84047-6518
US

V. Phone/Fax

Practice location:
  • Phone: 208-845-0321
  • Fax:
Mailing address:
  • Phone: 801-641-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW TUFT
Title or Position: OWNER
Credential: DDS
Phone: 208-845-0321