Healthcare Provider Details

I. General information

NPI: 1609438357
Provider Name (Legal Business Name): CHILDREN'S LANDING PEDIATRIC DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 W 7800 S STE 200
WEST JORDAN UT
84088-5563
US

IV. Provider business mailing address

3855 W 7800 S STE 200
WEST JORDAN UT
84088-5563
US

V. Phone/Fax

Practice location:
  • Phone: 801-282-1802
  • Fax: 801-282-6244
Mailing address:
  • Phone: 801-282-1802
  • Fax: 801-282-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL C TEW
Title or Position: OWNER
Credential: DDS
Phone: 801-282-1802