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General NPI Number Information
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NPI Number | 1649117557
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Entity Type | Organization
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Legal Business Name | ENOVAA DENTAL IMPLANT CENTER, PLLC
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 795 E WINCHESTER ST
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City | MURRAY
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State | UT
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Zip | 84107-7564
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Country | US
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Telephone | 801-630-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 795 E WINCHESTER ST
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City | MURRAY
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State | UT
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Zip | 84107-7564
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Country | US
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Telephone | 801-630-8811
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTRIST
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Name | PABLO OLLIVERIA BAUTISTA
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Credential | DDS
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Telephone | 801-630-8811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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