# UT BCDO SPECIALTY DENTAL SERVICES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Specialty Dental Brands
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669065470
- **Authorized official:** CHARLOTTE DASCH (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (504) 638-0303

## Contact information

- **Practice address:** 6973 S 4800 W STE C, WEST JORDAN, UT 84084-7927
- **Practice address phone:** (801) 840-4833
- **Mailing address:** 401 CHURCH ST STE 1400, NASHVILLE, TN 37219-2214
- **Mailing address phone:** (504) 638-0303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | NULL | — |
| 1223P0106X | Oral and Maxillofacial Pathology Dentistry | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 02/12/2021
- **Last updated:** 02/12/2021