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General NPI Number Information
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NPI Number | 1730667031
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Entity Type | Organization
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Legal Business Name | HM SALT LAKE
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 7138 S HIGHLAND DR STE 214
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-3783
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Country | US
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Telephone | 810-942-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 7138 S HIGHLAND DR STE 214
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-3783
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Country | US
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Telephone | 810-942-7770
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED HEPWORTH
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Credential |
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Telephone | 801-702-7478
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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 | 94365969922
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License Number State | UT
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