Healthcare Provider Details

I. General information

NPI: 1972299162
Provider Name (Legal Business Name): SMILE DOCTORS OF UTAH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E 900 S STE 300
SALT LAKE CITY UT
84105-1281
US

IV. Provider business mailing address

5400 LBJ FWY STE 800
DALLAS TX
75240-1058
US

V. Phone/Fax

Practice location:
  • Phone: 801-917-4746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GREGORY G GOGGANS
Title or Position: PRESIDENT
Credential: DMD
Phone: 719-569-5715