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General NPI Number Information
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NPI Number | 1992275945
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY COSMETIC & LASER DENTAL PLLC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 5742 ADAMS AVE PKWY
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City | OGDEN
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State | UT
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Zip | 84405-7157
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Country | US
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Telephone | 801-621-3383
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Fax |
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Provider Business Mailing Address
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Address Line | 5742 ADAMS AVE PKWY
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City | OGDEN
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State | UT
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Zip | 84405-7157
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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 | MBR
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Name | KEVIN ZAUGG
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Credential | DMD
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Telephone | 801-389-0647
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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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