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General NPI Number Information
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NPI Number | 1730455882
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Entity Type | Organization
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Legal Business Name | HART DENTAL
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 3566 PONY EXPRESS PKWY ST #1
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6018
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Country | US
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Telephone | 801-789-7500
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Fax | 801-789-7788
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Provider Business Mailing Address
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Address Line | 3566 PONY EXPRESS PKWY ST #1
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City | EAGLE MOUNTAIN
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State | UT
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Zip | 84005-6018
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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 | DENTIST
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Name | DR. RYAN RICHARD HART
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Credential | D.D.S.
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Telephone | 801-789-7500
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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 | 7729107-9921
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6248077-9922
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License Number State | UT
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