# STATION PARK PEDIATRIC DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Boardwalk Pediatric Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689300360
- **Authorized official:** DR. JAMES DOLL DMD (BOARD CERTIFIED PEDIATRIC DENTIST)
- **Authorized official phone:** (480) 278-6749

## Contact information

- **Practice address:** 1195 WEST PARK LN, FARMINGTON, UT 84025
- **Practice address phone:** (801) 882-8800
- **Mailing address:** 1195 WEST PARK LN, FARMINGTON, UT 84025
- **Mailing address phone:** (801) 882-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 07/26/2022
- **Last updated:** 07/26/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1770712838 | — | UT |