MEDICARE: NORTH VIEW DENTAL ASSOCIATES, LLC

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	144024-9922	UT

General Provider Information

NPI Number	:	1659776367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VIEW DENTAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2717 N HIGHWAY 89
Second Line	:	SUITE 100
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84404-1205
Country	:	US
Telephone Number	:	801-737-2410
Fax Number	:	801-737-5100

Provider Business Practice Location Address
First Line	:	2717 N HIGHWAY 89
Second Line	:	SUITE 100
City	:	PLEASANT VIEW
State	:	UT
Zip	:	84404-1205
Country	:	US
Telephone Number	:	801-737-2410
Fax Number	:	801-737-5100

Authorized Official
Title or Position	:	PARTNER/OWNER
Name	:	DR. PAUL A MACKLEY
Credential	:	DDS
Telephone Number	:	801-786-0500

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/24/2014

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