Healthcare Provider Details

I. General information

NPI: 1528742749
Provider Name (Legal Business Name): CM DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 02/21/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E STATE ST STE 1
LEHI UT
84043-1624
US

IV. Provider business mailing address

10 E STATE ST STE 1
LEHI UT
84043-1624
US

V. Phone/Fax

Practice location:
  • Phone: 801-766-3700
  • Fax:
Mailing address:
  • Phone: 801-766-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: KATIE PETERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-636-5792