MEDICARE: ADAM MCLACHLAN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	6836356-9922	UT

General Provider Information

NPI Number	:	1114219060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAM MCLACHLAN DDS PC

Provider Business Mailing Address
First Line	:	2043 E 2700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1720
Country	:	US
Telephone Number	:	801-467-4874
Fax Number	:	801-466-9400

Provider Business Practice Location Address
First Line	:	2043 E 2700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-1720
Country	:	US
Telephone Number	:	801-467-4874
Fax Number	:	801-466-9400

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADAM MCLACHLAN
Credential	:	DDS
Telephone Number	:	801-201-5462

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	05/11/2011

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