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General NPI Number Information
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NPI Number | 1467880716
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Entity Type | Organization
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Legal Business Name | TRAVERSE MOUNTAIN FAMILY DENTAL LLC
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 3940 TRAVERSE MOUNTAIN BLVD SUITE 102
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City | LEHI
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State | UT
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Zip | 84043-4914
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Country | US
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Telephone | 801-852-8211
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Fax | 801-901-1923
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Provider Business Mailing Address
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Address Line | 3940 TRAVERSE MOUNTAIN BLVD SUITE 102
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City | LEHI
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State | UT
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Zip | 84043-4914
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Country | US
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Telephone | 801-852-8211
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Fax | 801-901-1923
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. SCOTT F STAPLEY
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Credential | DDS
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Telephone | 801-852-8211
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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 | 8291219
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License Number State | UT
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