Healthcare Provider Details

I. General information

NPI: 1891944856
Provider Name (Legal Business Name): DEVIN MCCORMICK LINK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 W 1000 N
SALT LAKE CITY UT
84116-1654
US

IV. Provider business mailing address

220 W 7200 S SUITE A
MIDVALE UT
84047-1043
US

V. Phone/Fax

Practice location:
  • Phone: 801-328-5750
  • Fax: 877-497-4661
Mailing address:
  • Phone: 801-858-3461
  • Fax: 801-955-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7411635-9921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDR60024842
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: