Healthcare Provider Details

I. General information

NPI: 1326690017
Provider Name (Legal Business Name): VINEYARD HEIGHTS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 E MILL RD STE 302
VINEYARD UT
84059-5729
US

IV. Provider business mailing address

707 E MILL RD STE 302
VINEYARD UT
84059-5729
US

V. Phone/Fax

Practice location:
  • Phone: 801-901-3736
  • Fax: 385-283-0660
Mailing address:
  • Phone: 801-901-3736
  • Fax: 385-283-0660

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. JAMES CARVER STANDRING
Title or Position: CLINICAL DIRECTOR
Credential: DDS
Phone: 801-901-3736