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Organization
OUT OF THIS WORLD DENTISTRY PC
Active
Organization
OUT OF THIS WORLD DENTISTRY PC
Active
Other names
Out of This World Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DANNIELLE STARK (OFFICE MANAGER)
(801) 898-7502
Entity
Organization
Contact information
Practice address
112 E 12450 S STE 100, DRAPER, UT 84020-8057
(801) 571-6751
(801) 571-4156
Mailing address
112 E 12450 S STE 100, DRAPER, UT 84020-8057
(801) 571-6751
(801) 571-4156
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
144937
UT
Other
Enumeration date
08/21/2014
Last updated
08/21/2014
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