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General NPI Number Information
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NPI Number | 1932332798
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Entity Type | Organization
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Legal Business Name | ALL VALLEY DENTAL
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 1377 E. 3900 S. STE. 101
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City | SALT LAKE CITY
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State | UT
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Zip | 84124
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Country | US
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Telephone | 801-277-8222
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Fax | 801-272-4639
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Provider Business Mailing Address
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Address Line | 1377 E. 3900 S. STE. 101
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City | SALT LAKE CITY
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State | UT
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Zip | 84124
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Country | US
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Telephone | 801-277-8222
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Fax | 801-272-4639
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Authorized Official
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Title or Position | DOCTOR
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Name | JORDAN HEIMER
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Credential | DMD
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Telephone | 801-277-8222
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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