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General NPI Number Information
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NPI Number | 1780198564
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Entity Type | Organization
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Legal Business Name | TOOTH DOCTOR - WVC PLLC
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 3060 S REDWOOD RD
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3058
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Country | US
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Telephone | 801-972-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 3060 S REDWOOD RD
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3058
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Country | US
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Telephone | 801-972-0555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEVIN J ORVIN
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Credential | DDS
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Telephone | 801-989-7803
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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 | 88136909922
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License Number State | UT
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