MEDICARE: UTAH FAMILY DENTAL COTTONWOOD HEIGHTS

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

General Provider Information

NPI Number	:	1417575879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH FAMILY DENTAL COTTONWOOD HEIGHTS

Provider Business Mailing Address
First Line	:	394 S MAIN ST
Second Line	:
City	:	TOOELE
State	:	UT
Zip	:	84074-2746
Country	:	US
Telephone Number	:	435-849-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	7069 S HIGHLAND DR STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-3731
Country	:	US
Telephone Number	:	801-943-2222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AARON STOBBE
Credential	:	DMD
Telephone Number	:	435-849-1812

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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