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Organization
PEDOORTHO PARTNERS PLLC
Active
Organization
PEDOORTHO PARTNERS PLLC
Active
Other names
Clubhouse Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
VICENTA REYES (CREDNTIALING ,LEAD)
(972) 869-3789
Entity
Organization
Contact information
Practice address
5481 W 7800 S STE 120, WEST JORDAN, UT 84081-6027
(801) 542-0817
Mailing address
5481 W 7800 S STE 120, WEST JORDAN, UT 84081-6027
(801) 542-0817
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
NULL
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/22/2022
Last updated
03/22/2022
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