Healthcare Provider Details

I. General information

NPI: 1790790426
Provider Name (Legal Business Name): NORTHVIEW DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 N 400 E
NORTH OGDEN UT
84414-7210
US

IV. Provider business mailing address

2201 N 400 E
NORTH OGDEN UT
84414-7210
US

V. Phone/Fax

Practice location:
  • Phone: 801-782-6681
  • Fax: 801-786-0539
Mailing address:
  • Phone: 801-782-6681
  • Fax: 801-786-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PAUL A MACKLEY
Title or Position: OWNER
Credential: D.D.S.
Phone: 801-782-6681