Healthcare Provider Details

I. General information

NPI: 1760595706
Provider Name (Legal Business Name): ROCKY MOUNTAIN DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 ORCHARD DR
BOUNTIFUL UT
84010-5108
US

IV. Provider business mailing address

1480 ORCHARD DR
BOUNTIFUL UT
84010-5108
US

V. Phone/Fax

Practice location:
  • Phone: 801-295-7171
  • Fax:
Mailing address:
  • Phone: 801-295-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number4964666-9922
License Number StateUT

VIII. Authorized Official

Name: ROBERT W. ALBERTELLI
Title or Position: PRESIDENT
Credential: DDS
Phone: 801-295-7171