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General NPI Number Information
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NPI Number | 1649059387
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Entity Type | Organization
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Legal Business Name | PRESTIGE SMILES
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 218 E 800 S
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City | OREM
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State | UT
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Zip | 84058-5008
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Country | US
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Telephone | 801-610-7283
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Fax | 801-225-2537
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Provider Business Mailing Address
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Address Line | 218 E 800 S
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City | OREM
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State | UT
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Zip | 84058-5008
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Country | US
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Telephone | 801-610-7283
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Fax | 801-225-2537
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Authorized Official
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Title or Position | OWNER
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Name | KIRT FORAKIS
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Credential |
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Telephone | 801-610-7283
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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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