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General NPI Number Information
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NPI Number | 1982472536
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Entity Type | Organization
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Legal Business Name | ELEVATE DENTAL PARTNERS
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 533 W 2600 S STE 225
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City | BOUNTIFUL
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State | UT
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Zip | 84010-7762
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Country | US
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Telephone | 801-292-7500
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Fax | 801-292-7589
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Provider Business Mailing Address
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Address Line | 533 W 2600 S STE 225
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City | BOUNTIFUL
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State | UT
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Zip | 84010-7762
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DANIEL MASSON
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Credential | DDS
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Telephone | 801-897-7893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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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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