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General NPI Number Information
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NPI Number | 1376656017
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Entity Type | Organization
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Legal Business Name | SMILEWIDE DENTAL CARE PC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 5629 W. 13100 S.
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City | HERRIMAN
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State | UT
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Zip | 84096
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Country | US
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Telephone | 801-446-6889
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Fax | 801-446-6881
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Provider Business Mailing Address
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Address Line | 5629 W. 13100 S.
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City | HERRIMAN
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State | UT
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Zip | 84096
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Country | US
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Telephone | 801-446-6889
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Fax | 801-446-6881
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RODNEY JONATHAN THORNELL
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Credential | D.M.D.
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Telephone | 801-446-6889
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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 | 53235209922
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License Number State | UT
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