Healthcare Provider Details

I. General information

NPI: 1730581919
Provider Name (Legal Business Name): TRIPLE CROWN DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 E PARLEYS WAY SUITE 150
SALT LAKE CITY UT
84109-1667
US

IV. Provider business mailing address

2725 EAST PARLEYS WAY SUITE 150
SALT LAKE CITY UT
84109
US

V. Phone/Fax

Practice location:
  • Phone: 801-875-0570
  • Fax: 801-657-3745
Mailing address:
  • Phone: 801-875-0570
  • Fax: 801-657-3745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9030705-8903
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9030705-9922
License Number StateUT

VIII. Authorized Official

Name: DR. TAUREAN TRAVAS SMITH
Title or Position: GENERAL DENTIST
Credential: D.M.D.
Phone: 801-310-8244