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General NPI Number Information
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NPI Number | 1922308618
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Entity Type | Organization
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Legal Business Name | DENTISTRY FOR CHILDREN WEST VALLEY PC
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Dates
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Enumeration Date | 10/27/2010
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 3540 S 4000 W STE 440
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City | WEST VALLEY
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State | UT
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Zip | 84120-3295
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Country | US
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Telephone | 801-955-5200
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Fax | 801-955-1707
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Provider Business Mailing Address
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Address Line | 3540 S 4000 W STE 440
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City | WEST VALLEY
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State | UT
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Zip | 84120-3295
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Country | US
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Telephone | 801-955-5200
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Fax | 801-955-1707
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NANCY L DAVILA
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Credential |
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Telephone | 801-955-5200
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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 | 5247754
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License Number State | UT
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