MEDICARE: MACKAY DENTAL AND ASSOCIATES

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	5331693	UT
2	1223G0001X	General Practice Dentistry	5923241	UT
3	1223G0001X	General Practice Dentistry	134443	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	83693	OTHER	UT	PEHP DR DEMILLE
3	1990	OTHER	UT	PEHP DR LYNDON MACKAY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	73439	OTHER	UT	PEHP DR DAVID MACKAY

General Provider Information

NPI Number	:	1700821089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACKAY DENTAL AND ASSOCIATES

Provider Business Mailing Address
First Line	:	3550 S 4800 W
Second Line	:	SUITE J
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2966
Country	:	US
Telephone Number	:	801-969-3025
Fax Number	:	801-969-6115

Provider Business Practice Location Address
First Line	:	3550 S 4800 W
Second Line	:	SUITE J
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2966
Country	:	US
Telephone Number	:	801-969-3025
Fax Number	:	801-969-6115

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNDON C. MACKAY
Credential	:	D.D.S.
Telephone Number	:	801-969-3025

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/22/2020

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Directions to “MACKAY DENTAL AND ASSOCIATES ” Practice Location

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