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General NPI Number Information
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NPI Number | 1851538862
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Entity Type | Organization
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Legal Business Name | SALT LAKE DONATED DENTAL SERVICES
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 1383 S 900 W SUITE 128
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-1603
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Country | US
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Telephone | 801-983-0350
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Fax | 801-983-0353
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Provider Business Mailing Address
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Address Line | 1383 S 900 W SUITE 128
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City | SALT LAKE CITY
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State | UT
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Zip | 84104-1603
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Country | US
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Telephone | 801-983-0350
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. STEPHANIE M. JENSEN
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Credential |
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Telephone | 801-983-0351
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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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