Healthcare Provider Details

I. General information

NPI: 1063524296
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF UTAH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 W 3650 S
WEST VALLEY CITY UT
84119-4300
US

IV. Provider business mailing address

2960 W 3650 S
WEST VALLEY CITY UT
84119-4300
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-1681
  • Fax:
Mailing address:
  • Phone: 801-969-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JACK K. RASMUSSEN
Title or Position: PRESIDENT
Credential: DDS MAGD
Phone: 801-969-1681