Healthcare Provider Details

I. General information

NPI: 1326969676
Provider Name (Legal Business Name): MDG - SALT LAKE CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W 200 S STE 275
SALT LAKE CITY UT
84101-1464
US

IV. Provider business mailing address

440 W 200 S STE 275
SALT LAKE CITY UT
84101-1464
US

V. Phone/Fax

Practice location:
  • Phone: 801-321-7600
  • Fax:
Mailing address:
  • Phone: 801-321-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KELLEN MCWHORTER
Title or Position: OWNER
Credential: DMD
Phone: 801-358-8175