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General NPI Number Information
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NPI Number | 1760819924
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Entity Type | Organization
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Legal Business Name | GRANDPAS DENTAL CENTER LLC
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 294 W 800 N
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City | OREM
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State | UT
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Zip | 84057-3858
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Country | US
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Telephone | 801-374-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 294 W 800 N
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City | OREM
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State | UT
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Zip | 84057-3858
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Country | US
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Telephone | 801-374-5200
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MARCELO ABATTI
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Credential |
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Telephone | 801-374-5200
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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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