Healthcare Provider Details

I. General information

NPI: 1861860173
Provider Name (Legal Business Name): UTAH DENTAL UNITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 4500 S STE 150
SALT LAKE CITY UT
84107-3101
US

IV. Provider business mailing address

445 E 4500 S STE 150
SALT LAKE CITY UT
84107-3101
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-3236
  • Fax: 801-206-3236
Mailing address:
  • Phone: 801-266-3236
  • Fax: 801-206-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: CURTIS BRIMLEY
Title or Position: OWNER
Credential: DMD
Phone: 801-266-3236