Healthcare Provider Details

I. General information

NPI: 1609662089
Provider Name (Legal Business Name): THANKSGIVING POINT PDC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 W MAPLE LOOP DR STE 110
LEHI UT
84043-5717
US

IV. Provider business mailing address

727 SOUTH UTAH VALLEY DRIVE STE 300
AMERICAN FORK UT
84003
US

V. Phone/Fax

Practice location:
  • Phone: 801-766-4042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MARK CHRISTENSEN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 801-305-3460