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General NPI Number Information
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NPI Number | 1063032225
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Entity Type | Organization
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Legal Business Name | HAVEN DENTAL LLC
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Dates
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Enumeration Date | 04/17/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 2685 N 1000 W
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City | PLEASANT VIEW
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State | UT
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Zip | 84414-2660
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Country | US
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Telephone | 435-310-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 2797 N HIGHWAY 89 STE 300
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-1232
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Country | US
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Telephone | 801-786-0500
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Fax | 801-786-0520
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | SCOTT CRAVEN
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Credential | DDS
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Telephone | 801-786-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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