Healthcare Provider Details

I. General information

NPI: 1649967951
Provider Name (Legal Business Name): CECILIA SERRATO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 S 700 E STE 1
SALT LAKE CITY UT
84107-7900
US

IV. Provider business mailing address

4020 S 700 E STE 1
SALT LAKE CITY UT
84107-7900
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-2633
  • Fax:
Mailing address:
  • Phone: 801-263-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13348087-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: