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General NPI Number Information
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NPI Number | 1285044206
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Entity Type | Organization
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Legal Business Name | PRINCE DENTAL GROUP PLLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 210 E MAIN ST STE 201
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City | MIDWAY
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State | UT
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Zip | 84049-6817
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Country | US
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Telephone | 435-654-2822
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E MAIN ST STE 201
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City | MIDWAY
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State | UT
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Zip | 84049-6817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MATTHEW PRINCE
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Credential |
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Telephone | 435-654-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8006231-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5923720
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License Number State | UT
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