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General NPI Number Information
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NPI Number | 1730581919
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Entity Type | Organization
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Legal Business Name | TRIPLE CROWN DENTAL PLLC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 2725 E PARLEYS WAY SUITE 150
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-1667
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Country | US
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Telephone | 801-875-0570
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Fax | 801-657-3745
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Provider Business Mailing Address
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Address Line | 2725 EAST PARLEYS WAY SUITE 150
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City | SALT LAKE CITY
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State | UT
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Zip | 84109
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Country | US
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Telephone | 801-875-0570
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Fax | 801-657-3745
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. TAUREAN TRAVAS SMITH
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Credential | D.M.D.
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Telephone | 801-310-8244
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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 | 9030705-8903
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 9030705-9922
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License Number State | UT
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