MEDICARE: NORTH POINTE DENTAL

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7002323-9923	OTHER	UT	STATE OF UTAH DEPARTMENT OF COMMERCE

General Provider Information

NPI Number	:	1639885445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH POINTE DENTAL

Provider Business Mailing Address
First Line	:	1261 S 820 E STE 100
Second Line	:
City	:	AMERICAN FORK
State	:	UT
Zip	:	84003-3875
Country	:	US
Telephone Number	:	801-805-1934
Fax Number	:	801-805-1930

Provider Business Practice Location Address
First Line	:	10290 N NORTH COUNTY BLVD # 101
Second Line	:
City	:	HIGHLAND
State	:	UT
Zip	:	84003-8973
Country	:	US
Telephone Number	:	801-805-1934
Fax Number	:	801-805-1930

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	KENNA MUNSON
Credential	:
Telephone Number	:	385-219-9161

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	02/02/2023

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Directions to “NORTH POINTE DENTAL ” Practice Location

Language	Start Address	Practice Location

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