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General NPI Number Information
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NPI Number | 1396444337
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Entity Type | Organization
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Legal Business Name | MILLCREEK PDC PLLC
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 4110 S HIGHLAND DR STE 100A
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City | MILLCREEK
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State | UT
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Zip | 84124-2784
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Country | US
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Telephone | 801-506-6354
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 970681
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City | OREM
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State | UT
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Zip | 84097-0681
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Country | US
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Telephone | 801-506-6354
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | KAYLA SHADE
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Credential |
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Telephone | 801-305-3460
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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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