Healthcare Provider Details

I. General information

NPI: 1215554167
Provider Name (Legal Business Name): MVP DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 W PARK LN STE 100
FARMINGTON UT
84025-3665
US

IV. Provider business mailing address

625 E 500 S STE 203
BOUNTIFUL UT
84010-3884
US

V. Phone/Fax

Practice location:
  • Phone: 801-682-5810
  • Fax: 801-298-8573
Mailing address:
  • Phone: 801-292-6819
  • Fax: 801-298-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARLENE MCQUISTON
Title or Position: OFFICE MANAGER
Credential: DDS
Phone: 801-292-6819