Healthcare Provider Details

I. General information

NPI: 1295342202
Provider Name (Legal Business Name): VORTEX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6095 S FASHION BLVD STE 200
MURRAY UT
84107-7395
US

IV. Provider business mailing address

6095 S FASHION BLVD STE 200
MURRAY UT
84107-7395
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-4662
  • Fax:
Mailing address:
  • Phone: 801-262-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RANDY N DOWNING
Title or Position: OWNER
Credential: DDS
Phone: 801-262-4662