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General NPI Number Information
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NPI Number | 1689996928
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Entity Type | Organization
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Legal Business Name | SARATOGA PEDIATRIC DENTISTRY, LLC
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 02/26/2010
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Provider Practice Location Address
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Address Line | 245 E STATE ROAD 73
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045
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Country | US
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Telephone | 801-766-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 245 E STATE ROAD 73
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045
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Country | US
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Telephone | 801-766-8410
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATHAN E SMITH
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Credential | DDS
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Telephone | 801-766-3428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5602607-9923
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License Number State | UT
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