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Organization
PARK CITY PDC PLLC
Active
Organization
PARK CITY PDC PLLC
Active
Other names
Snow Country Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
1729 SIDEWINDER DR., STE 102, PARK CITY, UT 84060-7518
(435) 649-9492
(801) 692-9083
Mailing address
PO BOX 970309, OREM, UT 84097-0309
(801) 691-1701
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
352590747
UT
Other
Enumeration date
05/22/2017
Last updated
07/02/2021
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