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General NPI Number Information
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NPI Number | 1164156907
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Entity Type | Organization
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Legal Business Name | SERENE DENTISTRY OF NORTH SALT LAKE, PLLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 761 N REDWOOD RD STE 120
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2894
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Country | US
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Telephone | 385-300-8184
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Fax | 385-489-7775
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Provider Business Mailing Address
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Address Line | 761 N REDWOOD RD STE 120
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-2894
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Country | US
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Telephone | 385-300-8184
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Fax | 385-489-7775
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WILLIAM J BATES
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Credential | DDS
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Telephone | 801-458-8720
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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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