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General NPI Number Information
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NPI Number | 1285750554
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Entity Type | Organization
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Legal Business Name | LELAND W. PACK D.M.D., M.S. ORTHODONTICS & ASSOCIATES, INC.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 1067 24TH ST
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City | OGDEN
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State | UT
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Zip | 84401-2758
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Country | US
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Telephone | 801-621-5892
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 24TH ST
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City | OGDEN
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State | UT
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Zip | 84401-2758
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Country | US
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Telephone | 801-621-5892
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LELAND WILLIAM PACK
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Credential | D.M.D.,M.S.
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Telephone | 801-621-5892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 324142-9921
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License Number State | UT
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