MEDICARE: EMERGENCY DENTAL CARE WEST VALLEY

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	122300000X	Dentist		UT

General Provider Information

NPI Number	:	1295880367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY DENTAL CARE WEST VALLEY

Provider Business Mailing Address
First Line	:	484 W 800 N STE 202
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-3728
Country	:	US
Telephone Number	:	801-235-0911
Fax Number	:	801-235-0911

Provider Business Practice Location Address
First Line	:	2816 W 3500 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-3628
Country	:	US
Telephone Number	:	801-957-0911
Fax Number	:	801-957-1911

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. CHRIS WELLS
Credential	:
Telephone Number	:	801-235-0911

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/22/2020

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