Healthcare Provider Details

I. General information

NPI: 1255657722
Provider Name (Legal Business Name): BESTCARE DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 W 920 N
OREM UT
84057-3042
US

IV. Provider business mailing address

390 W 920 N
OREM UT
84057-3042
US

V. Phone/Fax

Practice location:
  • Phone: 801-225-0471
  • Fax: 801-225-4461
Mailing address:
  • Phone: 801-225-0471
  • Fax: 801-225-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number56798149922
License Number StateUT

VIII. Authorized Official

Name: DR. KYLE E FARLEY
Title or Position: MEMBER/MANAGER
Credential: DDS
Phone: 801-225-0471