Healthcare Provider Details

I. General information

NPI: 1962892653
Provider Name (Legal Business Name): PDC HIGHLAND PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 S HIGHLAND DR STE 400
SALT LAKE CITY UT
84106-3618
US

IV. Provider business mailing address

3098 S HIGHLAND DR STE 400
SALT LAKE CITY UT
84106-3618
US

V. Phone/Fax

Practice location:
  • Phone: 801-484-1032
  • Fax:
Mailing address:
  • Phone: 801-484-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number378380-9922
License Number StateUT

VIII. Authorized Official

Name: RHET SCHERSCHLIGT
Title or Position: DENTIST
Credential: DDS
Phone: 801-484-1032