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General NPI Number Information
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NPI Number | 1205404290
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Entity Type | Organization
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Legal Business Name | ENHANCE DENTAL- TROLLEY PLACE
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 530 E 500 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2707
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Country | US
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Telephone | 801-747-8015
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Fax |
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Provider Business Mailing Address
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Address Line | 530 E 500 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-2707
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Country | US
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Telephone | 801-747-8015
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | BENJAMIN BOWMAN
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Credential | DDS
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Telephone | 405-326-8004
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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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