Healthcare Provider Details

I. General information

NPI: 1578928172
Provider Name (Legal Business Name): SUGAR HOUSE DENTAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 S 1300 E STE L2
SALT LAKE CITY UT
84105-3675
US

IV. Provider business mailing address

1955 S 1300 E STE L2
SALT LAKE CITY UT
84105-3675
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-9649
  • Fax: 801-486-9640
Mailing address:
  • Phone: 801-486-9649
  • Fax: 801-486-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID THROUP
Title or Position: DOCTOR OWNER
Credential: DMD
Phone: 801-486-9649