Healthcare Provider Details

I. General information

NPI: 1982472536
Provider Name (Legal Business Name): ELEVATE DENTAL PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W 2600 S STE 225
BOUNTIFUL UT
84010-7762
US

IV. Provider business mailing address

533 W 2600 S STE 225
BOUNTIFUL UT
84010-7762
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-7500
  • Fax: 801-292-7589
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DANIEL MASSON
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 801-897-7893