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General NPI Number Information
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NPI Number | 1003138843
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Entity Type | Organization
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Legal Business Name | CHILDREN'S CROSSING PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 1528 N COMMERCE DR SUITE 100
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-4032
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Country | US
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Telephone | 801-766-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 1528 N COMMERCE DR SUITE 100
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-4032
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Country | US
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Telephone | 801-766-4900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFERY K RUPP
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Credential | DMD, MS
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Telephone | 801-635-4143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5352062
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License Number State | UT
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