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General NPI Number Information
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NPI Number | 1447922158
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHODONTIC CARE
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 5502 W 13400 S STE A
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City | HERRIMAN
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State | UT
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Zip | 84096-5636
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Country | US
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Telephone | 801-997-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 5502 W 13400 S STE A
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City | HERRIMAN
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State | UT
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Zip | 84096-5636
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Country | US
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Telephone | 801-997-5729
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE
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Name | TODD CHRISTENSEN
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Credential | DMD, MS
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Telephone | 801-997-5729
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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 |
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License Number State |
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