# SLPD COTTONWOOD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376044313
- **Authorized official:** DAVID B GUSTAFSON DDS (OWNER/DENTIST)
- **Authorized official phone:** (801) 463-1900

## Contact information

- **Practice address:** 7167 SOUTH HIGHLAND DRIVE, 200, COTTONWOOD HEIGHTS, UT 84121
- **Practice address phone:** (801) 463-1900
- **Practice address fax:** (801) 278-0481
- **Mailing address:** 7167 SOUTH HIGHLAND DRIVE, 200, COTTONWOOD HEIGHTS, UT 84121
- **Mailing address phone:** (801) 463-1900
- **Mailing address fax:** (801) 278-0481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/26/2018
- **Last updated:** 02/26/2018