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General NPI Number Information
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NPI Number | 1205042686
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Entity Type | Organization
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Legal Business Name | HILLSIDE DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 466 N MAIN ST #101
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City | CLEARFIELD
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State | UT
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Zip | 84015-3222
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Country | US
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Telephone | 801-776-8441
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Fax | 801-776-8428
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Provider Business Mailing Address
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Address Line | 644 N MAIN STREET #101
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City | CLEARFIELD
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State | UT
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Zip | 84015-3238
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Country | US
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Telephone | 801-776-8441
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Fax | 801-776-8428
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Authorized Official
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Title or Position | OWNER
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Name | RONALD KENT SCOVILLE
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Credential | DDS
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Telephone | 801-776-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4974568-0160
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License Number State | UT
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