MEDICARE: EMERGENCY DENTIST SALT LAKE CITY 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

General Provider Information

NPI Number	:	1952261554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY DENTIST SALT LAKE CITY LLC

Provider Business Mailing Address
First Line	:	622 E 4500 S STE 202
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	385-605-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 4500 S STE 202
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	385-605-3360
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW MARK BATEMAN
Credential	:	DMD
Telephone Number	:	385-605-3360

Provider Enumeration Date	:	11/15/2025
Last Update Date	:	11/15/2025

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