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General NPI Number Information
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NPI Number | 1750190070
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Entity Type | Organization
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Legal Business Name | WEEKEND DENTAL - UTAH LLC
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 2560 E 3300 S # 200
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City | MILLCREEK
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State | UT
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Zip | 84109-2749
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Country | US
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Telephone | 385-464-3520
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Fax |
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Provider Business Mailing Address
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Address Line | 6955 S UNION PARK CTR STE 510
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84047-6518
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Country | US
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Telephone | 801-641-8710
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PETER THEURER
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Credential | DDS
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Telephone | 469-525-2191
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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 |
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License Number State |
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