MEDICARE: LILAC DENTISTRY

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	:	1861342636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILAC DENTISTRY

Provider Business Mailing Address
First Line	:	1408 S 1100 E STE A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2400
Country	:	US
Telephone Number	:	801-828-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 S 1100 E STE A
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2400
Country	:	US
Telephone Number	:	801-828-5315
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAMIRA OVESON
Credential	:	DDS
Telephone Number	:	801-828-5315

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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Directions to “LILAC DENTISTRY ” Practice Location

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