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General NPI Number Information
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NPI Number | 1447609631
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF UTAH DENTAL SERVICES
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 50 N MEDICAL DR CLINIC 7
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City | SALT LAKE CITY
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State | UT
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Zip | 84132-0001
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Country | US
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Telephone | 801-581-2220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 841450
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City | LOS ANGELES
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State | CA
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Zip | 90084-1450
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Country | US
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Telephone | 801-213-3900
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Fax |
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Authorized Official
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Title or Position | DEPARTMENT CHAIR
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Name | JAMES H BEKKER
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Credential | DMD
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Telephone | 801-587-6336
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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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