Healthcare Provider Details

I. General information

NPI: 1649059387
Provider Name (Legal Business Name): PRESTIGE SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E 800 S
OREM UT
84058-5008
US

IV. Provider business mailing address

218 E 800 S
OREM UT
84058-5008
US

V. Phone/Fax

Practice location:
  • Phone: 801-610-7283
  • Fax: 801-225-2537
Mailing address:
  • Phone: 801-610-7283
  • Fax: 801-225-2537

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: KIRT FORAKIS
Title or Position: OWNER
Credential:
Phone: 801-610-7283