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General NPI Number Information
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NPI Number | 1912396060
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Entity Type | Organization
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Legal Business Name | WEST JORDAN SMILE CENTER
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 9251 S REDWOOD RD
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City | WEST JORDAN
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State | UT
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Zip | 84088-5814
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Country | US
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Telephone | 801-260-2847
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Fax |
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Provider Business Mailing Address
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Address Line | 9251 S REDWOOD ROAD
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City | WEST JORDAN
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State | UT
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Zip | 84008
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Country | US
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Telephone | 801-260-2847
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. KRISTIE KAPP
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Credential | RDH
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Telephone | 801-318-4572
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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 | 142531
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License Number State | UT
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