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Organization
PACIFIC WEST DENTAL GROUP
Active
Organization
PACIFIC WEST DENTAL GROUP
Active
Other names
Atlantis Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CATHILYN SELF (INSURANCE COORDINATOR)
(801) 614-0099
Entity
Organization
Contact information
Practice address
1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
(801) 614-0099
(801) 776-3661
Mailing address
1792 W 1700 S STE 101, SYRACUSE, UT 84075-9650
(801) 614-0099
(801) 776-3661
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4921068
UT
Other
Enumeration date
02/08/2012
Last updated
01/04/2016
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