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General NPI Number Information
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NPI Number | 1609662089
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Entity Type | Organization
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Legal Business Name | THANKSGIVING POINT PDC PLLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 2961 W MAPLE LOOP DR STE 110
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City | LEHI
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State | UT
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Zip | 84043-5717
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Country | US
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Telephone | 801-766-4042
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Fax |
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Provider Business Mailing Address
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Address Line | 727 SOUTH UTAH VALLEY DRIVE STE 300
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City | AMERICAN FORK
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State | UT
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Zip | 84003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MARK CHRISTENSEN
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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 | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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