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Organization
MSG DENTAL LLC
Active
Organization
MSG DENTAL LLC
Active
Other names
Cougar Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORBIN G MATTHEWS DMD (OWNER)
(801) 473-6455
Entity
Organization
Contact information
Practice address
835 N 700 E, PROVO, UT 84606-6993
(801) 373-7700
(801) 370-0762
Mailing address
835 N 700 E, PROVO, UT 84606-6993
(801) 373-7700
(801) 370-0762
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
372923
UT
Other
Enumeration date
12/06/2016
Last updated
12/06/2016
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