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General NPI Number Information
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NPI Number | 1386048171
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Entity Type | Organization
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Legal Business Name | RIVERTON HEIGHTS DENTAL CARE
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 3693 W 13400 S SUITE B
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City | RIVERTON
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State | UT
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Zip | 84065-6411
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Country | US
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Telephone | 801-878-3111
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Fax | 801-878-3444
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Provider Business Mailing Address
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Address Line | 3693 W 13400 S SUITE B
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City | RIVERTON
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State | UT
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Zip | 84065-6411
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Country | US
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Telephone | 801-878-3111
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Fax | 801-878-3444
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | BRIAN BORG
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Credential | D.M.D
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Telephone | 801-878-3111
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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 | 6227003-9922
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License Number State | UT
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